Computer-generated titanium cranioplasty: Report of a new technique for repairing skull defects

Abstract

A review of 40 cases of titanium cranioplasty fabricated from impressions taken of the defect through the patient's scalp in the conventional way showed that 23% were ill-fitting and 41% of frontal plates had a poor aesthetic result. Attributable factors were difficulty in defining the defect border accurately and limited information of the surrounding tissue architecture which led to strains produced during insertion. Inadequate communication between surgeon and prosthetist compounded these difficulties. A prospective study of six cases fabricated from CT computer-generated models of challenging cranial defects appears to show significant improvements in plate design, resulting in better plate adaptation, stability and aesthetic contour. Plate insertion was rapid (mean time 27 min) thereby minimizing operating time. This paper also discusses the advantages of the enhanced information derived from CT and describes the potential for pre-craniotomy template and matching cranioplasty, thereby permitting a one-stage procedure.

Stereolithography and the Use of Pre-Adapted / Fabricated Plates for Accurate Repair of Maxillofacial Defects

“…The data drives a laser over a bath of photosensitive resin ISSN: 2161-1173 Anaplastology, an open access journal Maxillofacial surgery Anaplastology which produces a series of stacked slices, which produce an accurate three-dimensional resin model [5]. This technique can be used by the maxillofacial surgeon to produce three-dimensional representations of the facial bony structures using data from CT or MRI scans [2][3][4][5][6][7][8][9][10]. In particular, it allows the maxillofacial surgeon to appreciate spatial displacements in all three dimensions and to make accurate measurement of the deformity.…”

“…However, prospective clinical studies are needed to demonstrate the value of stereolithographic modelling in reconstructive surgery [13]. The literature on stereolithography and its application in reconstructive surgery is limited to case reports and discussions about the feasibility of the technique [2][3][4][5][6][7][8][9][10][11][12][13]. There are no prospective studies demonstrating that the use of SMs improves the outcomes of reconstructive surgical procedures.…”

“…The correction of post-traumatic facial asymmetry and defects following major ablation surgery to remove malignancies have always been difficult [2,11]. Great accuracy is required to achieve successful surgical results, due to the fact that facial deformity and asymmetry is often the result of relatively small magnitudes of bony displacement or deformity.…”

“…Therefore, their use must be critically evaluated with regard to accuracy, informative value, cost and benefits in terms of improved diagnosis and better surgery. Stereolithography as a technique has been mainly used to fabricate a template for custom cranioplasty to cover defects in the skull [2][3][4][5][6][7][8][9][10]. Its application to the field of maxillofacial skeleton to fabricate and/or pre-adapt reconstructive plates has been limited to a few cases reported in the literature [11,12].…”

“…Successful rehabilitation, following ablative surgery for malignancy is likely to depend on the preoperative fitness score as outlined by the American Joint Cancer Committee (AJCC), [1] and the associated surgical trauma of the resection and reconstruction. Stereolithography, a preoperative technique, accurately measures and contours a reconstruction plate for the placement at the time of the skeletal resection [2][3][4][5][6][7][8]. It significantly decreases operating time and increases the surgeon's option to manage complex reconstructions (Table 1).…”