Intraosseous Venous Malformation of the Zygomatic Bone: Virtual Surgical Planning and Reconstruction With Customized CAD-CAM Titanium Implant

Abstract

intracutaneous suture techniques in Asian patients, which may help to obtain better scar outcome. After this modified combined sill and alar excision, the mean ratio of interalar distance to intercanthal distance changed significantly from preoperative 1.10 to postoperative 1.02. Before the surgery, there were 16 cases (30.8%) of horizon-shaped nostrils. After the surgery, the frequency significantly decreased to 2 cases (4.8%). The frequency of the pearshaped nostrils improved significantly from preoperative 15 cases (28.8%) to postoperative 26 cases (50.0%). The frequency of circular-shaped nostrils changed insignificantly from preoperative 21 cases (40.4%) to postoperative 24 cases (46.2%). These outcomes demonstrated our modified combined sill and alar excision could successfully narrow the wide nasal base and correct the alar flare. The shape of nostrils improved in most cases after the surgery. Some patients obtained no improvement of the shape of nostrils, which deserved further clinical exploration.Although the results of alar base excision are satisfying, we did not consider it as a routine surgery. Since the width of the nasal base and alar flare are directly affected by nasal tip projection and tip rotation. Alar width and flare would decrease following an increasing nasal tip projection due to a ''tent effect.'' 3 Some surgeons are not willing to perform such surgery in case of producing unnatural results or obvious scarring. We created the alar incision along the alar-facial groove and sutured the incision with intracutaneous suture techniques, which produced unnoticeable scar and could well hide the scar in the depth of the natural alar crease. This location of incision was in contrast with previous studies, which described the incision be placed above the crease to avoid crease obliteration. 12,14-16 However, obvious scar paralleled to the alar crease may be observed with this incision above the crease. For patients with wide alar base and without alar flare, we performed the alar excision with the incision located in the groove and closed the incision with intracutaneous suture techniques. The results were gratifying since the scar was well hidden and unobvious.One limitation in this current study is that it is a retrospective cohort study. There is no comparison group with incision above the crease, or with transcutaneous suture of incision, which can gain the strength of the study evidence. Therefore, a well-designed prospective study is needed to further investigate this issue. CONCLUSIONSWhen it is necessary to correct wide alar base and flare in Asian patients, we recommend a modified procedure with the incision for alar excision being placed in the alar-facial groove and closed by intracutaneous suture. This modified approach can obtain good scar outcomes and improve the shape of nostrils simultaneously.

Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature

“…The use of custom alloplastic implants has the advantage of reducing the surgical time and eliminating morbidity in the donor area [44,53]. One patient received a titanium PSI though VSP, cutting guides developed with CAD-CAM technology and STL models [54].…”