Toso Sabine Maria, Menzel Kerstin, Motzkus Yvonne, Adolphs Nicolai, Hoffmeister Bodo, Raguse Jan-Dirk
Department of Craniomaxillofacial Surgery, Surgical Navigation, Charité Universitätsmedizin Berlin, Berlin, Germany.
J Craniofac Surg. 2015 Oct;26(7):2133-5. doi: 10.1097/SCS.0000000000002142.
Application of endosseous implants in prosthetic craniofacial reconstruction represents a secure and reliable method and is a well-established surgical procedure. In areas of low bone presentation, standardized plate-like titanium implants are available. For allowing a congruent fitting to the recipient site, these contemporary implants have to be manually adapted--implicating drawbacks in terms of time consumption, technical complexity, and insufficient functional outcome. Owing to these limitations, a custom-made patient-specific implant is introduced based on Digital Imaging and Communications in Medicine (DICOM) data and designed for optimal prosthetic reconstruction.
For the first time, the application of a prefabricated patient-specific implant for retaining a craniofacial prosthesis is described. In a 64-year-old man with partial nasal defect standardized plate-like implants failed because of compromised bone quality due to Osler disease. To realize an implant-retained prosthetic reconstruction, a patient-specific implant was fabricated based on computer-aided design and computer-aided manufacturing (CAD/CAM) technology. This technique allows for considering the implant's ideal geometry as well as its correct placement of the required magnetic abutments. Furthermore, the surface of the implant can be designed for optimal hygienic conditions.
The patient-specific implant was successfully inserted in a time effective operating procedure. Follow-up at 6 months showed an excellent functional and aesthetic outcome.
Application of prefabricated patient-specific implants offers prospectively an ideal tool for retaining craniofacial prostheses and should be considered a viable option in standard cases, but obligatory in anatomically demanding defects.
骨内植入物在颅面修复假体中的应用是一种安全可靠的方法，也是一种成熟的外科手术。在骨量不足的区域，有标准化的板状钛植入物可供使用。为了与受体部位完美适配，这些现代植入物必须进行手工调整——这在时间消耗、技术复杂性和功能效果不足方面存在缺点。由于这些限制，基于医学数字成像和通信（DICOM）数据引入了定制的个性化植入物，并设计用于优化修复重建。
首次描述了一种预制的个性化植入物用于固定颅面假体的应用。在一名64岁患有部分鼻缺损的男性患者中，由于奥斯勒病导致骨质受损，标准化的板状植入物失败。为了实现植入物固定的修复重建，基于计算机辅助设计和计算机辅助制造（CAD/CAM）技术制作了个性化植入物。该技术能够考虑植入物的理想几何形状以及所需磁性基台的正确放置。此外，植入物的表面可以设计成具有最佳卫生条件。
个性化植入物在一次高效的手术过程中成功植入。6个月的随访显示功能和美学效果极佳。
预制的个性化植入物的应用前瞻性地为固定颅面假体提供了一种理想工具，在标准病例中应被视为一种可行的选择，但在解剖结构要求高的缺损病例中是必不可少的。
