title: Computer-assisted planning of distraction osteogenesis for lower face reconstruction in gunshot traumas.
abstract: OBJECTIVE
  Reconstruction of gunshot wounds of the lower face remains a challenge for the maxillofacial surgeon. We present our experience with the use of virtual surgery using Computer-Assisted Design (CAD)/Computer-Assisted Manufacturing (CAM) techniques to create a custom-made distraction device and prefabricated cutting guides (for both fibula and jaw osteotomies) and for device positioning.
  
  
  METHODS
  We describe two cases of lower face reconstruction after gunshot wounds by osteogenic distraction osteogenesis (DO) and computer-assisted surgery (SurgiCase CMF 5.0®software, Materialise). Surgical osteotomies and placement of the custom-made distraction device were performed intraoperatively based on prefabricated guides.
  
  
  RESULTS
  This fully digital preoperative planning improves the precision of osteotomies sites and distraction vectors. It largely reduces the operative time, with a greater operative safety.
  
  
  CONCLUSIONS
  Reconstruction by DO allows the bone and soft tissues to be simultaneously regenerated. However, the control of three-dimensional reconstruction of the lower face with distraction is difficult in facial gunshot patients because of the difficulties in locating anatomical landmarks. Surgical osteotomies are pre-planned and rapidly performed using a cutting guide. Precise placement of the distraction device is achieved without the need for subjective assessment of the sole surgeon. In our experience, the surgery has resulted in outcomes similar to those predicted by the computer-assisted planning.
authors.affiliation: Department of Maxillofacial and Plastic Surgery (Head: Prof. Hervé Bénateau), Caen University Hospital, 14000 Caen, France; Laboratory EA 4652 Microenvironnement Cellulaire et Pathologies (Head: Prof. Karim Boumediene), University of Caen Basse-Normandie, 14032 Caen Cedex 5, France; Medicine Faculty of Caen, University of Caen Basse Normandie, 2 rue des rochambelles, 14032 Caen Cedex 5, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Benateau
authors.affiliation: Department of Maxillofacial and Plastic Surgery (Head: Prof. Hervé Bénateau), Caen University Hospital, 14000 Caen, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Chatellier
authors.affiliation: Department of Maxillofacial and Plastic Surgery (Head: Prof. Hervé Bénateau), Caen University Hospital, 14000 Caen, France; Medicine Faculty of Caen, University of Caen Basse Normandie, 2 rue des rochambelles, 14032 Caen Cedex 5, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Caillot
authors.affiliation: Department of Maxillofacial and Plastic Surgery (Head: Prof. Hervé Bénateau), Caen University Hospital, 14000 Caen, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Labbe
authors.affiliation: Department of Maxillofacial and Plastic Surgery (Head: Prof. Hervé Bénateau), Caen University Hospital, 14000 Caen, France; Laboratory EA 4652 Microenvironnement Cellulaire et Pathologies (Head: Prof. Karim Boumediene), University of Caen Basse-Normandie, 14032 Caen Cedex 5, France; Medicine Faculty of Caen, University of Caen Basse Normandie, 2 rue des rochambelles, 14032 Caen Cedex 5, France. Electronic address: alexis.veyssiere@hotmail.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Veyssiere
mesh_terms: D000328:Adult; D017076:Computer-Aided Design; D006801:Humans; D008297:Male; D008338:Mandibular Injuries / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Distraction osteogenesis; Gunshots; Mandibular injuries