The use of rapid prototyping in the preoperative planning of distraction osteogenesis of the cranio-maxillofacial skeleton.
OBJECTIVE
In cranio-maxillofacial surgery, the principle of distraction osteogenesis (DO) can be used for the reconstruction of the deformed skull, midface complex, mandible and alveolar ridge. Optimal results can only be obtained with accurate planning of the osteotomies and accurate positioning of the distraction device. In addition, the surgical planning must be transferred very precisely to the patient in the operating theater. The clinical accuracy and utility of stereolithographic models in cranio-maxillofacial distraction osteogenesis of the midface, mandible and alveolar ridge will be demonstrated.


METHODS
Thirteen patients were treated by DO in the cranio-maxillofacial skeleton. Five patients suffered from midface retrusion and were treated by a LeFort III advancement. One patient suffered from an aseptic necrosis of the condylar process of the mandible and had a reconstruction of the condylar process by DO. Seven patients underwent an osteotomy of the alveolar ridge of the mandible with subsequent placement of distraction screws and implants because of advanced atrophy of the mandible. Following preoperative acquisition and conversion of the CT-scan data, a model was fabricated by stereolithography (SLA). Simulation of the osteotomies and placement of distraction devices was performed on these models, then surgical guides were used to transfer the surgical planning to the patient in the operating theater. Pre- and postoperative facial photographs and X-rays were compared to evaluate the accuracy of the transfer procedure.


RESULTS
In all cases, matching of pre- and postoperative facial photographs and X-rays showed reconstruction of the bony structures to be as accurate as planned on the SLA models. Transfer of the surgical plan by means of custom-made surgical guides was optimal in all cases.


CONCLUSIONS
Preoperative planning of distraction osteogenesis of the cranio-maxillofacial skeleton and transfer to the operating theater by custom-made surgical guides remains the standard procedure for the planning of complex distraction cases. However, improvements in surgical simulation software and accurate virtual-reality surgery will probably make the use of these models redundant in the future.
Poukens
Jules
J
Department for Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital Maastricht, Maastricht, The Netherlands. jpou@mkg.azm.nl
Haex
Jan
J
Riediger
Dieter
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006801:Humans; D008334:Mandible / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D019767:Maxillofacial Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D008953:Models, Anatomic; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D010780:Photogrammetry; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface