Management of extensive frontal cranioplasty defects.
Cranioplasty is a medical technique to correct cranial bone defects. Depending on the size and location of the defect, a bone substitute can be used to replace the missing bone. Frontal bone defects are important to patients in terms of cosmetics because they are visible. Advances in computer design allow the production of customized implants with improved cosmetic and functional results. This report describes hybrid optimization of three-dimensional technological methods along with traditional methods toward the manufacture of deep-buried titanium implants, restoring frontal skull defects for 4 patients. A three-dimensional model was produced from the computed tomographic scan data of 3 patients using an in-house three-dimensional printer. A new approach was followed in treating the fourth patient. The defect was restored using preoperative scan before cranioplasty. These data were transported digitally into the defect skull to recreate the bone contour required, and a three-dimensional model was produced from the "new" digital model using the three-dimensional printer. Defect areas of the patients were large and measured 101.21 × 123.35 (vertical × horizontal) in average (mm). Conventional wax-up of the defect was carried to restore normal conformity. A titanium sheet (0.5 mm) was swaged into the desired shape; however, convexity of the defect area makes titanium swaging challenging, especially at the deep lateral undercuts. Making side flanges at reasonable lengths made it easy to swage without creasing. Three-dimensional models aided to produce accurately fitting plates. Finally, the sequential method of using both digital and manual procedures is a low-cost, reliable, accurate, and reproducible method.
From the *Maxillofacial Unit, Maxillofacial Surgery, Queens Medical Centre Campus, Nottingham University Hospital, Nottingham, England; †Faculty of Applied Medical Science, Jordan University of Science and Technology, Irbid, Jordan; and ‡Neurosurgery Department, Queens Medical Centre Campus, Nottingham University Hospital Trust, Nottingham, England.
Muhanad M
MM
Hatamleh
Maria
M
Cartmill
Jason
J
Watson
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery; D003198:Computer Simulation; D017076:Computer-Aided Design; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D056424:Decompressive Craniectomy; D004954:Esthetics; D005624:Frontal Bone / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D066330:Printing, Three-Dimensional; D019736:Prostheses and Implants; D014025:Titanium; D014057:Tomography, X-Ray Computed
D014025:Titanium