Indications for Computer-Aided Design and Manufacturing in Congenital Craniofacial Reconstruction

Abstract

).Congenital craniofacial anomalies present a unique challenge due to future skeletal growth and soft tissue changes. These factors force the craniofacial surgeon to extend beyond threedimensional (3D) planning and develop a four-dimensional, temporal perspective. In current craniofacial practice, repairs often require intraoperative decision making without controlled objective planning. Outcomes have been contingent upon the ability of the surgeon to predict patterns of growth, envision a successful outcome, and execute a surgical plan. Historically, this was largely guided by two-dimensional images, 3D cast models, or determined intraoperatively.The development of computer-aided design and manufacturing (CAD/CAM) for virtual surgical planning (VSP) has enabled preoperative planning in three dimensions. AbstractThe complex three-dimensional relationships in congenital craniofacial reconstruction uniquely lend themselves to the ability to accurately plan and model the result provided by computer-aided design and manufacturing (CAD/CAM). The goal of this study was to illustrate indications where CAD/CAM would be helpful in the treatment of congenital craniofacial anomalies reconstruction and to discuss the application of this technology and its outcomes. A retrospective review was performed of all congenital craniofacial cases performed by the senior author between 2010 and 2014. Cases where CAD/CAM was used were identified, and illustrative cases to demonstrate the benefits of CAD/CAM were selected. Preoperative appearance, computerized plan, intraoperative course, and final outcome were analyzed. Preoperative planning enabled efficient execution of the operative plan with predictable results. Risk factors which made these patients good candidates for CAD/CAM were identified and compiled. Several indications, including multisuture and revisional craniosynostosis, facial bipartition, four-wall box osteotomy, reduction cranioplasty, and distraction osteogenesis could benefit most from this technology. We illustrate the use of CAD/CAM for these applications and describe the decision-making process both before and during surgery. We explore why we believe that CAD/CAM is indicated in these scenarios as well as the disadvantages and risks.

Virtual Surgical Planning Decreases Operative Time for Isolated Single Suture and Multi-suture Craniosynostosis Repair

“…No studies that measure the time difference in VSP compared with traditional open craniosynostosis have been published. The literature is largely restricted to small cases series, 6,10–15 and debate continues regarding production cost and prolonged assembly time. 16…”

Improving Aesthetic Outcome in Managing Acute and Chronic Upper and Midface Deformities Using Computer Assisted Planning

“…The main indication of 3D virtual planning and printing in cranio-maxillofacial surgery include orthognathic surgery, planning vectors and osteotomies in distraction ostiogenesis, acute and chronic traumatic maxillofacial fractures and deformities, cranioplasty, facial skeletal contouring and augmentation [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The study included 11 patients with acute and 14 patients with chronic deformities all of which are due to road traffic accidents.…”

“…There are inherent drawbacks to the use of advanced 3D computer technology, including potentially increased cost, the risk of infection or extrusion of alloplastic biomaterials, and unexpected discrepancies between simulated and actual operative results [7][8][9][10]13,19]. Employing 3D tech-nologies also does not absolve the surgeon from the responsibility of sound clinical judgment, planning, and execution.…”

Applications of Computer Technology in Complex Craniofacial Reconstruction

“…There are inherent drawbacks to the use of advanced 3D computer technology, including potentially increased cost, the risk of infection or extrusion of alloplastic biomaterials, and unexpected discrepancies between simulated and actual operative results. 18 – 21 , 24 , 30 Employing 3D technologies also does not absolve the surgeon from the responsibility of sound clinical judgment, planning, and execution. The educational role of 3D technology in craniofacial reconstruction also continues to be defined.…”