Customized polymethyl methacrylate implants for the reconstruction of craniofacial osseous defects

Abstract

Craniofacial defects represent alterations in the anatomy and morphology of the cranial vault and the facial bones that potentially affect an individual's psychological and social well-being. Although a variety of techniques and restorative procedures have been described for the reconstruction of the affected area, polymethyl methacrylate (PMMA), a biocompatible and nondegradable acrylic resin-based implant, is the most widely used alloplastic material for such craniomaxillofacial reconstruction. The aim of this study was to describe a technique for aesthetic and functional preoperative customized reconstruction of craniofacial bone defects from a small series of patients offered by the Brazilian public health system. Three adult male patients attended consultation with chief complaints directly related to their individual craniofacial bone defects. With the aid of multislice computed tomography scans and subsequent fabrication of the three-dimensional craniofacial prototype, custom-made PMMA implants were fabricated preoperatively. Under general anesthesia, with access to the craniofacial defects with a coronal approach, the PMMA implants were adapted and fixated to the facial skeleton with titanium plates and screws. Postoperative evaluation demonstrated uneventful recovery and an excellent aesthetic result. Customized prefabricated PMMA implants manufactured over the rapid prototyping models proved to be effective and feasible.

Figures

Figure 1

Clinical preoperative evaluation.

Figure 2

Preoperative 3D CT scans for Cases 1, 2, and 3 ((a), (b), and (c), resp.).

Figure 3

Preoperative customization of PMMA implants: initial aspect of the defect, wax covering the defects with a thickness-reduced wax, and PMMA reconstruction of the defect according to the desired anatomical contour (Case 1 ((a)–(c)), Case 2 ((d)–(f)), and Case 3 ((g)–(i))).

Figure 4

Intraoperative view of the defect and reconstruction with the PMMA implant (Case 1 ((a)-(b)), Case 2 ((c)-(d)), and Case 3 ((e)-(f))).

Figure 5

Clinical postoperative evaluation.