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In this unique case report, the authors have described a new method for the correction of unilateral craniofacial fibrous dysplasia by using sequential cutting guides. Due to the complex 3-dimensional anatomy of zygoma, it needs to be chiseled in multiple planes to mimic the normal contralateral side. To achieve this, 3 different guides were used one after the other to perform osteotomies in different planes and remove the excess fibrous bone.
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Displasia Fibrosa Craneofacial , Cirugía Asistida por Computador , Humanos , Tomografía Computarizada por Rayos X , Cigoma/diagnóstico por imagen , Cigoma/cirugía , Cirugía Asistida por Computador/métodos , Osteotomía/métodosRESUMEN
INTRODUCTION: Use of patient specific Polymethyl methacrylate (PMMA) implants for the reconstruction of cranial defects has become a standard practice with excellent long-term results. However, for the reconstruction of midface and mandibular osseous defects other alloplastic materials are preferred but their use is limited due to high cost. This is a report of our experience with the use of low-cost patient specific PMMA implants fabricated using 3D printed moulds in the reconstruction of osseous defects involving different areas of the facial skeleton not limited to cranium. METHODS: The 25 consecutive patients with craniofacial osseous defects who underwent reconstruction using customized PMMA implants were analyzed. All PMMA implants were fabricated intraoperatively with the use of 3D printed flexible moulds or templates. RESULTS: A total of 34 implants were used in 25 consecutive patients. Out of 34 implants 25 were used for midface and mandibular osseous defects. Most common etiology was post-traumatic deformity (nâ=â19) followed by tumor (nâ=â3), craniofacial anomalies (nâ=â2) and post-craniotomy (nâ=â1). One patient out of 25 (nâ=â1) had postoperative implant exposure. The follow-up was ranged from 3 to 19 months with an average of 12 months. The aesthetic outcome was found to be good to excellent with mean visual analogue score of 4.08. CONCLUSIONS: Polymethyl methacrylate implants fabricated intraoperatively using 3D printed moulds provide accurate and precise reconstruction at an exceptionally low cost. PMMA has an excellent moulding property with low infection rates. As shown in our study its application may be easily extended to all areas of the craniofacial skeleton.
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Implantes Dentales , Procedimientos de Cirugía Plástica , Estética Dental , Estudios de Factibilidad , Humanos , Polimetil Metacrilato , Impresión Tridimensional , Prótesis e Implantes , Cráneo/cirugíaRESUMEN
In this unique case report, we present a patient of left zygomatico maxillary complex reconstruction with a combination of autogenous tissue (osteocutaneous free fibula flap) and alloplastic implant [patient-specific templated polymethyl methacrylate (PMMA)]. In such large defects, reconstruction using either autogenous tissue or alloplastic implant alone is inadequate and leads to poor functional and aesthetic outcomes. In this case we used osteocutaneous free fibula flap for left alveolus and patient-specific templated PMMA implant for reconstruction of orbital wall and zygoma. Osseointegrated implants were placed secondarily in the fibula for complete dental rehabilitation. With the use of virtual surgical planning and 3D printing we were able to achieve a good result for a complex defect. Since both autogenous tissue and alloplastic implant were used for complete reconstruction, we have named this as "hybrid reconstruction."
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INTRODUCTION: Mandibular reconstruction always pose a challenge to the reconstructive surgeon. With the use of Computer aided designing and computer aided manufacturing (CAD-CAM) it is now possible to reconstruct mandibular defects to near normal configuration with good function and aesthetic outcomes. AIMS/OBJECTIVES: To compare the efficacy of CAD-CAM technique vs conventional technique in mandibular reconstruction with free fibula flap. MATERIALS AND METHODS: 40 consecutive patients that required mandibular reconstruction using free fibula flap were included in the study. All patients were treated using CAD-CAM technique and then compared retrospectively with 40 patients treated with conventional technique. Comparison was done between total intraoperative time, aesthetic outcome and post-operative occlusion. RESULTS: Total intraoperative time in the CAD-CAM group was significantly reduced (562 min) as compared to the conventional group (662 min). Patients in the CAD-CAM group also obtained a better Aesthetic score (3.6/5) when compared to the conventional group (2.5/5). Postoperative malocclusion was noted in 1 patient in the CAD-CAM group as opposed to 6 patients in the conventional group. CONCLUSION: Use of CAD-CAM technology in mandibular reconstruction with free fibula flap offers reduced surgical time with precise and accurate reconstruction that produces better functional and aesthetic outcomes.
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Diseño Asistido por Computadora , Peroné/trasplante , Colgajos Tisulares Libres/cirugía , Enfermedades Mandibulares/cirugía , Reconstrucción Mandibular/métodos , Adolescente , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Adulto JovenAsunto(s)
Consenso , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/terapia , Atención Primaria de Salud/normas , Amputación Quirúrgica/estadística & datos numéricos , Antibacterianos/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Pie Diabético/etiología , Estilo de Vida Saludable , Humanos , Hipoglucemiantes/uso terapéutico , Incidencia , India/epidemiología , Atención Primaria de Salud/métodosRESUMEN
We used composite conchal cartilage graft for columellar lengthening in eight patients with unilateral cleft lip and a nasal deformity. In 16 patients we used a buccal mucosal graft to line the nasal vestibule. We also used corrective procedures such as alveolar bone grafting for closure of palatal fistulas, septoplasty, malar augmentation, nasal osteotomy, and Le Fort I osteotomy to deal with associated deformities. Grafts took well with no loss and no donor site morbidity. In the follow up of 8 months-3 years, corrections were found to be stable and satisfying to all the patients. Only by replacing deficient tissues with similar tissues and putting them in the proper anatomical position can long term consistent and reliable results be achieved in the correction of nasal deformities associated with unilateral cleft lip.
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Labio Leporino/cirugía , Nariz/anomalías , Nariz/cirugía , Rinoplastia/métodos , Adolescente , Adulto , Proceso Alveolar/trasplante , Trasplante Óseo , Cartílago/trasplante , Niño , Femenino , Fístula/cirugía , Humanos , Masculino , Mucosa Bucal/trasplante , Osteotomía , Hueso Paladar/cirugía , Resultado del Tratamiento , Cigoma/cirugíaRESUMEN
INTRODUCTION: Colour duplex ultrasound (CDU)-guided sclerotherapy is a valuable modality for treating peripheral vascular malformations (PVMs). PATIENTS AND METHODS: Between April 1996 and October 1998, 75 patients (age 5-65 years) with PVMs were subjected to CDU. Sclerotherapy was subsequently performed on 40 patients, without sedation, using 3% sodium tetradecyl sulfate, with mean follow-up of 4 years. RESULTS: CDU of the 33 high-flow lesions (HFLs) revealed direct arteriovenous (AV) communicating channels with very high forward diastolic flow in seven lesions (arteriovenous fistulas, AVFs), but not in the other 25 lesions (non-AVF). One was a mixed lesion picked up by CDU. Sixteen HFLs were subjected to sclerotherapy; 13 (81.25%) regressed. CDU of the 42 low-flow lesions (LFLs) helped categorize them into Type 1, where no supplying arteries could be seen (12 lesions), and Type 2, where supplying arteries were seen (30 lesions). Type 2 lesions could be further subcategorized based on the spectral trace of their supplying arteries: Type 2a, high-resistance flow (25 lesions); and Type 2b, low-resistance flow with a small forward diastolic flow (5 lesions). Twenty-four LFLs were subjected to sclerotherapy; 20 (83.3%) regressed. CONCLUSION: CDU findings correlated well with the clinical appearances of PVMs, and helped to further subcategorize these lesions based on flow. Significant differences in the Doppler flowmetry parameters of the supplying arteries seen in the HFLs and LFLs have enabled us to suggest values for differentiating between them. CDU was also found to be valuable in the follow-up of these lesions.