title: Bilateral Malar Reconstruction Using Patient-Specific Polyether Ether Ketone Implants in Treacher-Collins Syndrome Patients With Absent Zygomas.
abstract: The authors performed bilateral malar reconstruction using polyether ether ketone implants in 3 patients with Treacher-Collins syndrome with absent, as opposed to hypoplastic, zygomata. These patient-specific implants were fabricated using computed-aided design software reformatted from three-dimensional bony preoperative computed tomography images. The first time the authors performed this procedure the implant compressed the globe resulting in temporary anisocoria that was quickly recognized intraoperatively. The implant was immediately removed and the patient made a full-recovery with no ocular disturbance. The computer-aided design and manufacturing process was adjusted to include periorbital soft-tissue boundaries to aid in contouring the new implants. The same patient, and 2 further patients, subsequently underwent malar reconstruction using this soft tissue periorbital boundary fabrication process with an additional 2 mm relief removed from the implant's orbital surface. These subsequent procedures were performed without complication and with pleasing aesthetic results. The authors describe their experience and the salutary lessons learnt.
authors.affiliation: *Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK †Centre for Craniofacial Care and Research, Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: David C G
authors.initials: DC
authors.lastname: Sainsbury
authors.forename: Alan
authors.initials: A
authors.lastname: George
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Forrest
authors.forename: John H
authors.initials: JH
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D001577:Benzophenones; D002648:Child; D017076:Computer-Aided Design; D004955:Esthetics, Dental; D005145:Face / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007659:Ketones / Q000627:therapeutic use*; D008297:Male; D008342:Mandibulofacial Dysostosis / Q000601:surgery*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011108:Polymers; D019736:Prostheses and Implants; D014057:Tomography, X-Ray Computed / Q000379:methods; D015050:Zygoma / Q000002:abnormalities* / Q000601:surgery
chemical_list: D001577:Benzophenones; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols