Craniomaxillofacial surgery

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Customized titanium implant fabricated in additive manufacturing for craniomaxillofacial surgery

André Luiz Jardini, Maria Aparecida Larosa, Cecília Amélia de Carvalho Zavaglia, Luis Fernando Bernardes, Carlos Salles Lambert, Paulo Kharmandayan, Davi Calderoni & Rubens Maciel Filho

Virtual and Physical Prototyping

Customised implants manufacture has always presented difficulties which result in high cost and complex fabrication, mainly due to patients’ anatomical differences. The solution has been to produce prostheses with different sizes and use the one that best suits each patient. Additive manufacturing (AM) as a technology from engineering has been providing several advancements in the medical field, particularly as far as fabrication of implants is concerned in craniomaxillofacial surgery. The use of additive manufacturing in medicine has added, in an era of development of so many new technologies, the possibility of performing the surgical planning and simulation by using a threedimensional (3D) physical model, very faithful to the patient’s anatomy.

AM is a technology that enables the production of models and implants directly from the 3D virtual model (obtained by a Computer-Aided Design (CAD) system, computed tomography or magnetic resonance) facilitating surgical procedures and reducing risks. Furthermore, additive manufacturing has been used to produce implants especially designed for a particular patient, with sizes, shapes and mechanical properties optimised, for areas of medicine such as craniomaxillofacial surgery. This work presents how AM technologies were applied to design and fabricate a biomodel and customised implant for the surgical reconstruction of a large cranial defect. A series of computed tomography data was obtained and software was used to extract the cranial geometry. The protocol presented was used for creation of an anatomic biomodel of the bone defect for the surgical planning and, finally, the design and manufacture of the patient-specific implant.

Please note:

This abstract was published on Bonash Medical’s website since its content was related to the company’s products. There is no relation between Bonash Medical and the authors. To have full access to the article, please refer to relevant reference.

Custom made cranioplasty

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Custom made titanium cranioplasty early and late complications of 151 cranioplasties and review of the literature.

R. Williams, K. F. Fan, R. P. Bentley

Int. J. Oral Maxillofac. Surg.

A diverse range of techniques is available for reconstruction of full-thickness calvarial defects and the optimum substrate for cranioplasty remains unproven. During a 9-year period, 149 patients underwent insertion of 151 custom-made titanium cranioplasties using the same technique. Data relating to patient demographics, indication for cranioplasty, and site and size of the defect were collected from the clinical records. Patients were followed up in all cases for a mean of 1 year 2 months (range 7 days to 8 years 8 months). Early complications requiring intervention were experienced in 7% and included seroma, haematoma, and continued bleeding necessitating implant removal in one patient.

One death occurred at 3 days’ post-operation due to haemorrhagic stroke. Late self-limiting complications such as seroma were experienced in 19% of patients, however complete failure requiring implant removal was seen in only 4% of cases. Infection was the cause of failure in all cases. A comprehensive literature review was carried out and data abstracted to compare reported failure rates in other techniques of full-thickness cranial reconstruction. This review shows that custom-made patient specific titanium cranioplasties compare very favorably to the other published techniques and remain a tried and tested option for reconstruction of all sizes of full-thickness calvarial defect.

Please note:

This abstract was published on Bonash Medical’s website since its content was related to the company’s products. There is no relation between Bonash Medical and the authors. To have full access to the article, please refer to relevant reference.