Computer-assisted design of sequential surgical procedure for oblique facial clefts with mandibular outer cortex autografts.

Abstract

Oblique facial clefts are congenital craniofacial malformations affecting the paramedian line of facial structures. Correction of these defects involves bone and soft tissue reconstruction. The authors have developed a computer-aided sequential surgical procedure for oblique facial clefts, including mandibular outer cortex autografting, medial canthal ligament reduction and fixation, and fat autografting. From 2004 to 2013, 12 patients (9 women, 3 men) with oblique facial clefts were treated with the 3-step procedure in our clinic. Mean patient age at the first surgery was 18 years (range, 13-25 years). Preoperative three-dimensional surgical simulations assisted the surgeries. A retrospective review of patients' clinical, photographic, and radiographic records was performed. All patients achieved significant treatment effects and high satisfaction. The patients' self-assessed scores on a 10-point scale of deformity severity were lower after surgery (P < 0.001) and remained stable after 6 to 12 months (P = 0.069). Good repositioning of the inner canthus was achieved (P < 0.001) with no significant relapse (P = 0.096). The mean (SD) recovery of mandibular donor sites was 48.44% (16.89%) (range, 11.03%-71.33%). Grafted bone absorption was not significantly different at different recipient sites. Only minor complications occurred in 6 patients. This procedure was an effective treatment for oblique facial clefts, resulting in high satisfaction, remarkable improvements in facial symmetry, little skin scarring, acceptable bone graft resorption, and dramatic recovery of mandibular donor sites. Computer-assisted surgical simulation effectively describes characteristic skeletal deformities and provides a useful guide to surgical reconstruction.