Craniomaxillofacial Surgery with Computer-generated Three-dimensional Solid Models

Abstract

Objectives: Restoring complex craniofacial deformities presents numerous challenges. Recent years have seen the development of new surgical techniques aimed at improving operation quality and reducing difficulty. However, designing the reduction volume for the affected region and achieving precise contouring remain difficult tasks. The use of three-dimensional (3D) solid models can provide significant assistance at all stages of the operations. This study aimed to investigate the validity of prototype 3D solid models for complex craniofacial operations.

Methods: Simulated 3D models of the patients were used. Conventional surgical instruments were employed for the planning of the operations. Patients had follow-up periods ranging from 6 to 18 months.

Results: Operations have been planned and performed using three-dimensional solid models. Intraoperative steps were executed as simulated during planning. No major complications were developed. All bone and soft-tissue reconstructions healed without major infection.

Conclusion: Stereolithographic models provide: 1) a better understanding of anatomy, 2) presurgical simulation, 3) intraoperative accuracy in lesion localization, 4) accurate fabrication of implants, and 5) improved education for trainees. An accurate method for intraoperative navigation and preoperative planning is clearly useful. This technology offers a direct representation of the patient's anatomy through computer reconstruction, allowing for the efficient and precise transfer of information in complex facial restorative procedures.

Keywords: Craniofacial surgery; three-dimensional model; training model.

Figure 1

Solid model of a 10-year-old boy presented with a tumor originating from the frontal bone and upper pole of the zygomatic arch. Arrows mark the tumoral extension (a) worms eye view (b) view from above (c) frontal view (d) side view. Intraoperative images of the patient. Arrow shows the location of the tumor (e) exposed facial bones after dissection (f) Image of the cranial bones after separation of the effected area (g) Image of the area after removal of the tumor with a portion of the zygomatic arch and frontal bone (h) Image of the bone defect repaired using split-thickness cranial bone grafts.

Figure 2

Image of the patient with bone tumor. (a) Preoperative image from frontal view (b) worms eye view (c) Postoperative image from frontal view (d) worms eye view.

Figure 3

Image of a 21-year-old girl presented with fibrous dysplasia, resulting in severe deformity and asymmetry on the left side of her face (a) Preoperative image from frontal view (b) Preoperative image of the 3D solid model (c) Side image of 3D model identifying zygoma (A) and coronoid process (B) which had osseous prominence acting as a locking mechanism (C) (d) View from above of the solid model.

Figure 4

(a) Image of the solid model of the patient from side view superimposed with actual segments removed inside the surgery (A) zygomatic arch (B) inferior orbital rim (C) coronoid process. (b) Image of the segments removed during surgery (c) preoperative planning on the solid model.

Figure 5

Image of 3D solid model for planning surgical intervention and osteotomy lines (a) frontal view (b) oblique view.

Figure 6

Preoperative images of 4-year-old boy presented with an unusual facial cleft extending from the midline of the maxilla (between the incisor teeth) to the frontal bone (a) frontal view (b) worms eye view (c) side view. Postoperative images of the patient whose excess bone fragments were removed and severe orbital hypertelorism was corrected through orbital repositioning to the frontal bone (d) frontal view (e) worms eye view (f) side view