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Facial reconstruction using STL
Temporomandibular joint and mandibular ramus reconstruction using STL techniques
Case presented by
Dr. D. Trikeriotis, Dr. P. Diamantopoulos, Dr. I. Paravalou, Dr K. Gavakos, Dr N. Zotalis from Oral and Maxillofacial Surgery Unit of "Agia Olga" Hospital, Athens, Greece and Bio-Medical Modelling Unit of the University of Sussex, UK
A 26-years-old female suffers from a left hemifacial microsomia (Type III, Pruzansky). Using Mimics software (1) a 3D virtual skull of the patient is produced. The left glenoid fossa , condyle and ascending ramus were absent and the left zygomatic arch was hypoplastic. Because of the co-existing severe hypoplasia of the masseteric muscles the chin was deviated toward the affected left side. Despite the previous osteotomies performed in both jaws this young patient was functionally and aesthetically still suffering.
As a second step a STL model of the skull has been made by Materialise. On this bio-model after achieving and waxing up the preferred dental occlusion a precise implant design and manufacturing process was undertaken by TMJ Concepts. (2)
The implant was composed of two parts:
- A temporal component for the reconstuction of the absent glenoid fossa
- A mandibular component for the reconstruction of the absent condyle and deficient left mandible.
The preferred position and length of the fixation screws were also measured and evaluated. (3)
During surgery the temporal component was precisely and easily adapted and fixated. (4)
In a similar way the mandibular component was placed. (5)
On the pictures, you can see how the patient looked before (6A) and after the reconstruction without left chin deviation.
After two weeks intermaxillary fixation was applied. (6B)
A month after surgery there was no deviation during the opening position. A more effective masticatory function and a more acceptable aesthetic result were achieved. (7)
Using the STL model in this patient with hemifacial microsomia the disturbed anatomy of the facial skeleton was thoroughly studied. A complex preoperative reconstruction planning such as the implant-design and manufacturing process was done with high accuracy. During surgery both implant components were safely fixated on the anatomical sites without any need for further manual adaptation. This would never been possible without making a STL model. Even more, less surgical time and tissue stress were observed.