Image-Guided Titanium Implantation for Craniofacial Prosthetics

Abstract

Osseointegration implants have revolutionized craniofacial prosthetic reconstruction. Implant placement relies on adequate thickness and quality of bone to permit osseointegration. Positioning the implant is critical in craniofacial reconstruction because surface contours of the prosthesis must be preserved while housing attachment components securely and discretely. Also, the position of the final prosthesis must transition to native tissue smoothly. We report on the use of intraoperative stereotactic image guidance in the placement of implants for orbital, nasal, and auricular prosthetic reconstruction. Clinical data, intraoperative images, and postoperative rehabilitated results are presented to demonstrate the utility of the application of stereotactic image guidance for implant placement. In our experience, stereotactic image guidance facilitates optimal implant site selection if there is abnormal bone quantity or quality.

Systematic Review of Clinical Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Nasal Prostheses

“…Further digital advancement is now leading the surgeons toward intra-operative image-guided navigation. Stereotactic navigation during craniofacial bone-anchored implant placement eliminates the need for a physical surgical guide and gives surgeons the ability to simultaneously work within the anatomical defect while being guided through radiographic data in real time [51][52][53]. Bell [54] described registration as "the process of correlating the anatomic references to the digitized dataset".…”

Image-Guided Placement of Osseointegrated Implants for Challenging Auricular, Orbital, and Rhinectomy Defects

“…There are publications demonstrating the use of intraoperative image-guided placement of OPI, but these are limited to simple craniofacial defects. 5,13 This report highlights the use of OPI to reconstruct challenging craniofacial defects that can involve more than 1 anatomic site or a free flap that obscures the underlying bony anatomy.…”

“…The implant relies on sufficient bone stock at the implant site to allow for optimal osseointegration. 5 Appropriate implant positioning is also critical in head and neck reconstruction. Osseointegrated prosthetic implants require strategic placement to maximize stability and retention while maintaining the aesthetics of the prosthesis.…”

Osseointegrated Implants for Orbito-Facial Prostheses: Common Complications and Solutions

“…In the literature, various preoperative and intraoperative 2D and 3D imaging protocols have been described to decide excellent implant positioning. 36,37 In our study, two-dimensional orbito-cranial computerized tomography including axial, coronal, and sagittal scans in 3-mm sections were recorded for each patient to evaluate the quality and quantity of the orbital bone structure. At least 3 implants are required for adequate retention and long term survival of the implants.…”

“…Another issue with regard to osseointegration is the proper placement of the orbital implants. In the literature, various preoperative and intraoperative 2D and 3D imaging protocols have been described to decide excellent implant positioning 36,37 . In our study, two-dimensional orbito-cranial computerized tomography including axial, coronal, and sagittal scans in 3-mm sections were recorded for each patient to evaluate the quality and quantity of the orbital bone structure.…”