Computer-guided contouring of craniofacial fibrous dysplasia involving fronto-orbital or fronto-cranial region using patient specific surgical depth guide: A prospective case series.

The aim of this study was to introduce a new computer guided technique for debulking and contouring the craniofacial fibrous dysplasia involving the fronto-orbital and fronto-cranial regions. Computer-guided contouring was performed using a modified patient-specific surgical depth guide for six patients with craniofacial fibrous dysplasia involving the fronto-orbital and fronto-cranial regions. Virtual planning was performed to determine the desired amount of bone removal and construct the patient-specific surgical depth guide. Then, the guide was printed using rapid prototyping. In the surgical theatre, the guide was seated in position. Implant drills were inserted through the created depth holes according to the planned fixed depth to create depth holes. Finally, the bone in between the created holes was removed using cutting discs, bone chisels and surgical burs. Satisfaction with facial aesthetics was evaluated by the patients using a Likert scale, and by the surgeons using the Whitaker rating scale. The surgical procedures were uneventful for all the patients. All the patients were satisfied with the post-operative facial esthetics and categorized as category I Whitaker rating scale. Patient-specific surgical guide technique for recontouring of fronto-orbital and fronto-cranial fibrous dysplasia can be considered an accurate substitution technique that overcomes the drawbacks of the unpredictable conventional one. Further investigations are required.

Computer guided calvarial bone grafting for reconstruction of orbital floor blow out fracture.

BACKGROUND: Calvarial grafts represents a superior option for orbital floor reconstruction, however the difficulty of intraoperative moulding and placement remains as a major limitation. We used patient specific guides and sterolithographic models to facilitate this procedure. METHODS: The study was conducted on 10 patients with orbital floor blow out fracture. A graft harvesting guide was virtually constructed based on the defect using mirroring of the normal side. The virtual guide and the defective orbital floor were then printed. The graft was harvested using the guide and adjusted to the defect using the model, finally seated in place. RESULTS: All patients showed no enophthalmos or diplopia. Orbital volume was comparable for both traumatised and normal orbits with no statistical significance difference (p value 0.28), and orbital volume ratio was 101.76 ± 4.7%. CONCLUSION: The use of graft harvesting guide and orbital floor models for intraoperative graft moulding showed promising results.