Reconstruction of Bilateral Post-Traumatic Midfacial Defects Assisted by Three-Dimensional Craniomaxillofacial Data in Normal Chinese people—A Preliminary Study

Abstract

To provide reference data for reconstruction of bilateral midfacial defects for which "mirror technique" cannot be applied. The present study included 4 patients (3 males and 1 female) with post-traumatic bilateral midfacial fractures and defects. The most similar model was retrieved from a database of 552 normal Chinese people and used to guide preoperative virtual surgery planning. All patients underwent open reduction, internal fixation, and reconstruction surgery in 1 stage. A custom-made titanium prosthesis was used to repair the defects of frontal and naso-orbital-ethmoid (NOE) region in 1 patient. Two fibular flaps were used to repair the maxillary defects. A deep circumflex iliac artery flap was used to reconstruct large midfacial defects involving the right zygoma. A surgical navigation system was applied in 3 patients. The 4 patients were followed for 6 to 42months. Two patients had finished all therapies and had satisfactory functional and cosmetic results. The appearance of 1 patient was obviously improved; that patient was still receiving treatment for denture prostheses. One patient had undergone first-stage reconstructive surgery and had normal occlusion at 6months of follow-up. For 3 patients whose treatment had been assisted by navigation, the average surgical deviation was less than 3mm (range, 1.5 to 2.2). For the patient whose treatment had not been assisted with navigation, the deviations differed in different areas: 3.47mm in the right zygomaticomaxillary complex, 5.48mm in the NOE area, and 5.91mm in the maxillary area. For patients with bilateral post-traumatic midfacial defects across the midline, the use of a 3-dimensional craniomaxillofacial database can be considered a feasible method for providing reference data for preoperative planning.