Advanced technology in the management of fibrous dysplasia.
BACKGROUND
The aim of this paper is to describe the applications of advanced imaging technology in optimising the surgical management of complex craniofacial fibrous dysplasia (FD).


METHODS
Preoperative planning involved a number of advanced technologies. Haptic modelling was used to simulate tumour excision and the design of the osteotomies, on a virtual 3D computerised tomographic (CT) scan. Rapid prototyping was employed in fabricating a physical prototype of the skull, featuring the ideal, symmetrical reconstruction. Tumour extirpation was carried out with the aid of stereotactic navigation. Intraoperatively, resorbable mesh is moulded precisely to the shape of the skull prototype, thereby transferring the surgical simulation to the patient in the operating room. The resorbable mesh serves as a template which guides the shape and spatial orientation of an autologous bone graft reconstruction. Pre- and postoperative volumetric differences were assessed to determine the accuracy of the final results.


RESULTS
Short and long term follow-up examinations show excellent cosmetic outcome, with significant restoration of volumetric symmetry.


CONCLUSIONS
The added complexity of using the new technologies increases preoperative planning time, but we believe that this is offset by the improved safety during the resection of the tumours as well as the excellent aesthetic outcomes.
Murray
D J
DJ
Toronto Adult Craniofacial Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Edwards
G
G
Mainprize
J G
JG
Antonyshyn
O
O
D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D004954:Esthetics; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005359:Fibrous Dysplasia, Polyostotic / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D010027:Osteotomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000000981:diagnostic imaging / Q000601:surgery*; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome