Maxillectomies cause malocclusion, masticatory disorders, swallowing disorders and poor nasolabial projection, with consequent esthetic and functional sequelae. Reconstruction can be achieved with conventional approaches, such as closure of the maxillary defect by microvascular free flap surgery or prosthetic obturation. Four patients with segmental maxillary defects that had been reconstructed with customized subperiosteal titanium maxillary implants (CSTMI) through virtual surgical planning (VSP), STL models and CAD/CAM titanium mesh were included. The smallest maxillary defect was 4.1 cm and the largest defect was 9.6 cm, with an average of 7.1 cm. The reconstructed maxillary vertical dimension ranged from 9.3 mm to 17.4 mm, with a mean of 13.17 mm. The transverse dimension of the maxilla at the crestal level was attempted to be reconstructed based on the pre-excision CT scan, and these measurements ranged from 6.5 mm in the premaxilla area to 14.6 mm at the posterior level. All patients were rehabilitated with a fixed prosthesis on subperiosteal implants with good esthetic and functional results. In conclusion, we believe that customized subperiosteal titanium maxillary implants (CSTMI) are a safe alternative for maxillary defects reconstruction, allowing for simultaneous dental rehabilitation while restoring midface projection. Nonetheless, prospective and randomized trials are required with long-term follow-up, to assess its long-term performance and safety.

(1) Background: In recent years, three-dimensional (3D) templates have replaced traditional two-dimensional (2D) templates as visual guides during intra-operative carving of the autogenous cartilage framework in microtia reconstruction. This study aims to introduce a protocol of the fabrication of patient-specific, 3D printed and sterilizable auricular models for autogenous auricular reconstruction. (2) Methods: The patient’s unaffected ear was captured with a high-resolution surface 3D scan (Artec Eva) and post-processed in order to obtain a clean surface model (STL format). In the next step, the ear was digitally mirrored, segmented and separated into its component auricle parts for reconstruction. It was disassembled into helix, antihelix, tragus and base and a physical model was 3D printed for each part. Following this segmentation, the cartilage was carved in the operating room, based on the models. (3) Results: This segmentation technique facilitates the modeling and carving of the scaffold, with adequate height, depth, width and thickness. This reduces both the surgical time and the amount of costal cartilage used. (4) Conclusions: This segmentation technique uses surface scanning and 3D printing to produce sterilizable and patient-specific 3D templates.

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(1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain can be achieved by using the preoperative virtual planning of mandibular reconstruction using a free fibula flap compared with freehand plate bending and osteotomies. (2) Methods: A retrospective comparative study was carried out in the Oral and Maxillofacial Department of La Paz University Hospital, Madrid, Spain. The study compared 18 patients in the CAD/CAM group with 19 patients in the conventional freehand group. A comparison was made between the total surgical time, the comorbidities, and the hospital stay. The resource consumption was estimated using a cost analysis. (3) Results: Although CAD/CAM was a statistically more expensive procedure in the perioperative phase, no significant differences were observed in total health care costs between the two groups. There was a non-significant trend towards an increase in complications with conventional reconstruction plates compared to patient-specific plates (PSI). (4) Conclusions: CAD/CAM technology and a 3D printed cutting guide offer a significantly shorter surgical time, which is associated with a reduction in hospital days, PACU days, and complications. The cost of CAD/CAM technology is comparable to that of the conventional freehand technique.

Virtual surgical planning allows orthognathic surgeons to design a surgical plan preoperatively and establish a personalized surgical protocol. This study aims to validate the predictability and accuracy of orthognathic surgery through a comparison of the three-dimensional (3D) models of the virtual planning and postoperative CBCT using free software (3D Slicer) on 40 patients who underwent bimaxillary orthognathic surgery. The distances of point A, point B, pogonion (Pog), and the first upper and lower molars, both in each axis (x, y, and z) and in the 3D space, were analyzed. The median of the distances in the mediolateral direction was the lowest, while the highest differences were found at point A and Pog in the anteroposterior direction (0.83 mm and 0.78 mm, respectively). Vertical differences were higher in the maxilla than in the mandible. In conclusion, we found that orthognathic bimaxillary surgery using virtual surgical planning was more accurate when positioning the bone segments in the mediolateral direction, using the information provided by the splint, as well as when positioning the mandible compared to the maxilla.