In Support of Using Computer-Aided Design and Modeling for Periorbital Osteotomies

Abstract

Three-dimensional virtual surgical planning using computer-aided design and modeling (CAD/CAM) has gained popularity in planning complex orthognathic and osteocutaneous free flap reconstructions of the head and neck because of its ability to guide complex geometric planning in three-dimensional space and save time in the operating room. The purpose of this study was to review our experience using CAD/CAM concepts in periorbital osteotomies. Three complex periorbital osteotomies were planned and performed: 1 case of bilateral vertical and horizontal orbital dystopia, 1 case of a Monobloc-Le Fort II in an Apert patient, and 1 case of recurrent hypertelorism in a patient with craniofrontal nasal dysplasia. The patients' charts were reviewed, including photographs, medical records, and CAD/CAM plans. The CAD/CAM planning sessions were held 3 to 6 weeks preoperatively and lasted approximately 1 hour. Both cutting guides and positioning guides were used, translating to significant precision of both the osteotomy as well as the final position of the orbits. Qualitatively, the cutting and positioning guides were easy to use and improved operating room efficiency. To conclude, in our hands, CAD/CAM virtual surgical planning is safe and effective in the performance of complex periorbital osteotomies. More work is needed to more clearly define surgical indications for this costly, new technology.

A critical appraisal of surgical outcomes following orbital hypertelorism correction: what is the incidence of true bony relapse versus soft tissue telecanthus?

“…Given the inherent complexity of OHT correction, the application of computer-assisted design and computer-assisted manufacturing (CAD/CAM) in craniomaxillofacial surgery represents a promising strategy drawing upon [34]. The use of three-dimensional (3D) printing and stereolithographic models based on preoperative imaging allows for surgical planning tailored to the unique differences in patient anatomy often encountered in OHT.…”

Advanced Three-Dimensional Technologies in Craniofacial Reconstruction

“…Tahiri and Taylor describe a case series that includes facial bipartition, box osteotomy, and monobloc fronto-orbital advancement using custom cutting and positioning guides. 23 Paliga et al also detail monobloc advancement using computer-aided design and manufacturing combined with a halo distractor. 69 Engel et al describe a case of severe orbital hypertelorism corrected using a three-dimensional model.…”

“…8,21,22 Today, three-dimensional models, surgical guides, and patient-specific custom implants are used for model surgery, anatomical replica manipulation, replacement of significant bone or composite tissue defects, patient-specific custom implant fabrication or fit assessment, or augmentation of surgical education. 1,3,4,[6][7][8][9]23,24…”