Rapid prototype modeling and customized titanium plate fabrication for correction of a persistent hard palate defect in a dog

Abstract

An 8-month-old crossbred dog was evaluated because of an oronasal fistula following 2 previous attempts to surgically correct a secondary palate defect. Three months after initial evaluation and successful closure of the soft palate section of the secondary palate defect via 2 surgeries, an oronasal fistula was present. The oronasal fistula was predominantly right sided, involving the rostral third of the hard palate and, at the widest aspect, spanning the transverse palate at the level of the maxillary canine teeth. Following CT of the rostral aspect of the skull, rapid prototyping technology was used to create a stereolithographic model of the skull, allowing fabrication of a customized titanium plate for intranasal stenting. The titanium plate was inserted via a rostral nasal approach and secured rostrally with 1.5-mm screws and caudally with 2.4-mm screws from the nasal bridge. An oronasal fistula formed laterally at the edge of the plate, but bonding of a dental glass ionomer product resulted in successful resolution of the fistula. Results suggested that rapid prototyping and creation of customized implants may provide an option for the management of large or nonreconstructible oronasal defects in dogs.