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Refining Post–Orthognathic Surgery Facial Contour with Computer-Designed/Computer-Manufactured Alloplastic Implants

Lee, Jeffrey H., M.D.; Kaban, Leonard B., M.D., D.M.D.; Yaremchuk, Michael J., M.D.

Plastic and Reconstructive Surgery: September 2018 - Volume 142 - Issue 3 - p 747–755
doi: 10.1097/PRS.0000000000004652
Pediatric/Craniofacial: Original Articles
Discussion

Background: Le Fort I maxillary osteotomies and sagittal split mandibular osteotomies are performed to correct significant dentofacial deformities. The multidimensional skeletal movements, particularly those of large magnitude, may result in contour irregularities and facial imbalances.

Methods: Three-dimensional images were reconstructed from computed tomographic scans in patients unhappy with their appearances after Le Fort I advancement and/or bilateral sagittal split osteotomies. The data from these scans were used to produce alloplastic implants using computer-aided design/computer-aided manufacturing for surgical correction of contour irregularities and imbalances. These implants were surgically placed through intraoral and submental incisions and fixed using titanium screws.

Results: A total of 21 patients underwent implant placement with implants produced using computer-design/computer manufacturing. One patient required removal of implants secondary to infection. All other patients were satisfied with their result.

Conclusion: The use and surgical placement of implants produced by means of computer-aided design/computer-aided manufacturing has been shown to be effective in refining appearance in 21 patients over a 7-year period with minimal morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Boston, Mass.

From the Division of Plastic and Reconstructive Surgery and the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital.

Received for publication June 24, 2017; accepted March 6, 2018.

Disclosure: Dr. Yaremchuk is a consultant for Matrix Surgical. The other authors have no financial interest to declare.

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Jeffrey H. Lee, M.D., 55 Fruit Street, Boston, Mass. 02114, dr.lee@jeffreyleemd.com

©2018American Society of Plastic Surgeons