Application of computer techniques in repair of oblique facial clefts with outer-table calvarial bone grafts

This study focused on the application of computer-aided and rapid prototyping techniques in the repair of oblique facial clefts with outer-table calvarial bone.

Five patients with oblique facial clefts underwent repair with outer-table calvarial bone. A mirror technique and rapid prototyping techniques were applied to design and prefabricate the individualized template for the preoperative repair of orbital inferior wall and maxillary anterior wall defects. Using computer software, the ideal region from which to take outer-table calvarial bone was located according to the size and surface curvature of the individualized template. During the operation, outer-table calvarial bone was fixed according to the shape of the individualized template, and bone onlay grafting was carried out after appropriate trimming. Surgical accuracy was evaluated by comparing the preoperative and postoperative 3-dimensional reconstructed images.

With computer-aided and rapid prototyping techniques, all 5 patients had an ideal clinical outcome with few complications. The 3-dimensional preoperative design images and postoperative images fit well. Six-month to 8-year postoperative follow-up demonstrated that 4 patients had good aesthetic facial appearances and 1 had developed recurrence of lower eyelid shortage.

Computer-aided and rapid prototyping techniques can offer surgeons the ability to accurately design individualized templates for craniofacial deformity and perform a simulated operation for greatly improved surgical accuracy. These techniques are useful treatment modalities in the surgical management of oblique facial clefts.