Abstract
This paper presents a methodological procedure, based on the anatomical reconstruction and constrained deformation, to design custom-made implants for forehead augmentation in people affected by Apert syndrome, experiencing a frontal bone deficiency. According to the anthropometric theory, a cranial landmarks identification procedure was applied to retrieve, from a repository, a healthy skull, used as reference geometry for implant modelling. Then, using constrained deformation and free-form modelling techniques, it was possible to design a patient-specific implant. At last, the implant was realised using a custom mould, specially designed according to the patient’s needs to provide an accurate fit of the defect site. The design procedure was tested on a patient suffering from Apert syndrome. Three implants were virtually modelled and 3D-printed for pre-surgical evaluation. Their shapes were 3D compared with a reference one (handcrafted by a surgeon) to test the accuracy. Deviations are negligible, and the customised implant fulfilled the surgeon’s requirements.
Highlights
Craniofacial skeleton reconstruction is challenging, primarily when congenital diseases affect the symmetry of the skull with complex and irregular defects
& Thin plate spline (TPS) interpolation or deformation: this method comprises interpolation functions able to generate an approximation of the skull surface at the lesion site by warping and deforming a target based on two sets of homologous points defined over both a reference model and a target
The patient under study exhibited a forehead covered by a metallic mesh, due to previous surgical treatments, that compromised any chance of osteointegration
Summary
Craniofacial skeleton reconstruction is challenging, primarily when congenital diseases affect the symmetry of the skull with complex and irregular defects. Depending on the lesion complexity (size and location), the aesthetic recovery, the functional requirements and the technical considerations established by the surgeon, different design techniques are available for the reconstruction of craniomaxillofacial defects:. & Mirrored imaging technique: this method consists of mirroring the sound side of the skull over the contralateral part and subsequently apply a Boolean difference to get the implant. This method is suitable for skulls with low asymmetry and unilateral lesions [4,5,6] and for significant defects which do not cross the midline. TPS is not convenient when dealing with extensive defect areas
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