title: Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data.
abstract: Reconstruction of craniofacial bone defects by intraoperative modelling of autogenous or alloplastic materials may cause undesirable results concerning the implant shape or the long-term maintenance of this shape. Furthermore, the use of alloplastic materials to be modelled intraoperatively may result in an inflammatory tissue response. Therefore the question is raised whether CAD/CAM-techniques may be used for the pre-operative geometric modelling of the implant based on helical computed tomography data. A numerically based 3-dimensional model of the skull defect serves as the basis for a freeform-surfaces design of the implant shape, position and thickness, using modelling tools and programmes developed for industrial CAD/CAM. The precise and individual fit of the implant results from generating its margins by the borders of the defect, whereas the implant surface is generated by the geometry of the non-affected neighbouring bone contours. The implant data run a numerically controlled milling machine to fabricate the individual implant. The reconstruction of post-traumatic defects of the forehead, of post-surgical temporal defects after intracranial haemorrhage, and of a parieto-occipital defect due to ablative tumour surgery are presented as the first clinical experiences of this new method.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Knappschaftskrankenhaus, University Hospital Bochum, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Eufinger
authors.forename: M
authors.initials: M
authors.lastname: Wehmöller
authors.forename: E
authors.initials: E
authors.lastname: Machtens
authors.forename: L
authors.initials: L
authors.lastname: Heuser
authors.forename: A
authors.initials: A
authors.lastname: Harders
authors.forename: D
authors.initials: D
authors.lastname: Kruse
mesh_terms: D000293:Adolescent; D000328:Adult; D002543:Cerebral Hemorrhage / Q000601:surgery; D017076:Computer-Aided Design; D003399:Craniotomy / Q000534:rehabilitation; D004867:Equipment Design; D005147:Facial Bones / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005546:Forehead / Q000293:injuries / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008579:Meningioma / Q000601:surgery; D008768:Methylmethacrylates; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery; D010294:Parietal Bone / Q000601:surgery; D011300:Preoperative Care; D019736:Prostheses and Implants; D012117:Resins, Synthetic; D012886:Skull / Q000000981:diagnostic imaging* / Q000601:surgery*; D013701:Temporal Bone / Q000601:surgery; D014025:Titanium; D014057:Tomography, X-Ray Computed
chemical_list: D008768:Methylmethacrylates; D012117:Resins, Synthetic; D014025:Titanium