Esthetic Occipital Augmentation With Computer-Aided Design–Computer-Aided Manufacturing Prefabricated Customized Polymethyl Methacrylate Implant: Comparison of Planned and Final Results

Abstract

Augmentation of the occiput is an esthetic procedure that is gaining more popularity but is not well reported in the literature. The aim of this retrospective study on a case series of patients was to describe the use of computer-aided design-computer-aided manufacturing prefabricated polymethyl methacrylate (PMMA) implants in esthetic occipital augmentation. Furthermore, comparison between the surgical outcome and the digital planning was carried out to ascertain the replicability of the surgical planning. We performed a retrospective study of a case series of patients who underwent occipital augmentation with computer-aided design-computer-aided manufacturing prefabricated implants. Customized PMMA occipital implants were fabricated and were inserted via a bicoronal approach with patients under general anesthesia. The patients' 1-week postoperative cone-beam computed tomography image was superimposed onto the preoperative virtual planning images, and the positions of the actual implant and virtual implant were compared. A total of 15 patients who were treated at Charm Clinic, Taipei, Taiwan, and received occipital implants for esthetic purposes were included in this study. The percentage overlap of the occipital implant ranged from 87.8% to 99.99% (mean, 95.71%). One patient experienced partial wound dehiscence, which recovered after wound revision and suturing. In another patient, mild hematoma developed, which resolved spontaneously. Although no formal questionnaire was administered, all patients expressed satisfaction with the cosmetic outcome. The use of prefabricated PMMA posterior calvarial implants showed a rate of replicability of 87.8% to 99.99% (mean, 95.71%) compared with the preoperative virtual planning, and we recommend it as a feasible method for esthetic occipital augmentation.