A New Orbito-Zygomatic Complex Reconstruction Technique Using Computer-Aided Design and Manufacturing-Assisted Harvest of Autologous Calvarial Bone in Cases of Orbito-Zygomatic Benign Tumor.

The orbito-zygomatic complex (OZC) includes several key structures, and its destruction leads to the impairment of functional activities such as nutrition, communication, nasal support, and vision. Management of benign tumors of the OZC is therefore a surgical challenge because of the necessity for reconstruction of these elements. Autogenous bone is considered the gold standard for reconstruction. Nevertheless, there is difficulty related to the complex anatomy and distorted skeletal anatomic landmarks, which require precise work in the case of bone grafts. The aim of this report is to propose a new reconstruction technique consisting of OZC reconstruction with computer-aided design and manufacturing of autologous calvarial bone. Three cases are presented. After performing tumor resection using computer-aided design and manufacturing cutting guides, we used a piezotome to perform osteotomies and preserve the periosteum and sinus mucosa. The SinpliciTi system (Materialise, Châtillon, France) allowed us to make cutting guides and a 3-dimensional surgical plan of the shapes and ideal positions of the calvarial bony plates for the OZC reconstruction. Calvarial osteotomies were performed using a piezotome through the polyamide calvarial cutting guide to obtain the shapes designed beforehand. Once the samples were collected, the shapes could be assembled ex vivo and then put in place through a minimally invasive approach. We discuss the advantages and limitations of our reconstruction method and its place in the management of OZC reconstruction.