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Reconstruction Of The Jaws After Facial Trauma: Implants, Orthodontics, And Maxillofacial Surgery

Reconstruction of secondary deformities after facial trauma is a major challenge for maxillofacial surgeons. A surgeon with experience in orbitopalpebral surgery, rhinoplasty, and orthognathic surgery in combination with orthodontics, pre-prosthetic surgery, and implants are required. The management of avulsions of the alveolar process with implants is essential.

The combination of aesthetic and reconstructive surgery technique produces the best results, except in small deformities, the approach requires multiple surgeries due to its complexity. After pan facial fractures, sequelae are frequent, especially if orbitozygomatic and nasoethmoidal are combined. In complex fractures with dental and alveolar process losses, it is difficult to achieve intermaxillary immobilization and perfect fracture reduction.

If the sequelae of fractures are complex and affect several areas, the best results are obtained if an organized approach is performed with exposure of the fracture areas, reduction of these after maxillary and orbital osteotomies, rigid fixation and autologous bone grafts are mainly taken from the shell.

Clinical Case

The 32-year-old patient was referred for facial and maxillary reconstruction after suffering a traffic accident with a facial pan fracture that affected both orbits, nasoethmoidal, and maxillary.

The patient had previously undergone surgery by non-maxillofacial surgeons and had various sequelae. The frontal view shows a significant orbital malposition with enophthalmos of the left orbit, vertical orbital dystopia, and telecanthus; the nose is deviated and lateralized, shifting to the left. The septum is deviated to the left with a C deformity, resulting in nasal respiratory failure. The maxilla is retroposition and displaced to the left with missing teeth, coronary fractures, and left crossbite. The profile view highlights the sinking of the nasal root and the lack of lip support due to edentulism and fracture of the maxilla. The chin is rearranged.

Facial Reconstruction: Contributing To The Quality Of Life Of Patients

Within the subspecialty of facial and reconstructive plastic surgery, one of the most requested procedures is the post-trauma facial reconstruction and oncological surgery, and the correction of scars, since, improving the damage caused by accidents or diseases, It turns out to be a support for the person’s self-esteem.

When the face’s appearance is affected by an accident or illness, facial reconstruction surgery becomes very important.

This may include scar revision and correction, tissue loss repair, treatment of vascular birthmarks, surgery for craniofacial deformities, or reconstruction after cancer surgery.

All of the above is mainly covered by the management of facial, functional, or restorative plastic surgery.

However, in facial and reconstructive plastic surgery, the most frequent are the corrections of scars on the face “product of multiple causes, such as previous accidents or previous surgeries in which an unsightly scar remained, and correction is needed to improve the quality life of the patient.

The scar will not be erased, but it will certainly improve your appearance as well as the person’s self-esteem.

For the same reason, these interventions work as a complement to oncological surgeries. Currently, we do them, facial plastic surgeons; because we have the appropriate oncological tools and plastic surgery techniques for it, and the scar that one can offer the patient with the reconstruction procedure is much more aesthetic. There are cases in which the person presents a large lesion due to basal cell cancer, which will leave a very unsightly scar if not resected and rebuilt properly. Then, the idea is that it can also be a cosmetic reconstruction without neglecting the proper treatment of cancer.

If we talk about more complex stages, it is also used for large facial resections, such as a maxillectomy.

The surgeon must have the tools to reconstruct a maxilla or a mandible. In the case of the nose, it is done through different types of advanced reconstruction, such as regional flaps or flaps with microsurgery, which is a more complicated procedure that involves tissue transfer from another area of ​​the patient to join it using the microvascular technique.

Most common facial repairs

  • Scars of different sizes and types, anywhere on the face.
  • Reconstructions in children for damage caused by a dog bite. These scars can be old or recent, and, ideally, a plastic surgeon intervenes them from the first moment to obtain better results. They are also frequent in adults.

Interventions for tumor lesions on the face, moles, and skin cancer. They are performed for aesthetic reasons, and dermatologists generally refer to these patients.…

3D Printing To Perform A Facial Reconstruction

The titanium implants have been created from a scanner of the patient’s undamaged areas to achieve perfect symmetry in the reconstruction.

Lately, it is most common to dawn with the discovery of new uses for materials such as graphene or, almost to a greater extent, technologies such as 3D printing. And as it could not be less today, at Think Big, we inform you again about the multiple functions that this type of technology encompasses.

The images obtained are being used to create, through 3D printing, titanium implants that will allow a perfect facial reconstruction. It is a pioneering reconstruction system that is considered to mean an almost total restoration of a person’s facial symmetry.

Traditionally, the implants used for facial reconstruction are flexible metal plates, but in this case, the injuries from the accident were a real challenge.

However, through the tomographic scanner used to create the implants using 3D printing, it is possible to know exactly how and where to place the printed bones. The guides and implants have been produced in medical titanium in one of the most prestigious 3D printing complexes.

Thus, all surgery has been planned virtually, and the patient is still waiting for the intervention. However, the prognosis could not be better based on the statements of the medical team in charge. Without a doubt, a breakthrough in the field thanks once again to the use of technology.

Background

Surgery of the mouth, head, neck, face, and jaws (oral and maxillofacial surgery) is particularly difficult since numerous delicate and vital organs and structures generally surround the operated area. 3D printing technology allows to personalize the therapeutic process and increase the precision, precision and, consequently, the safety of the treatment

3D printed organ and bone models based on MRI or CT scans help prepare implants before surgeries and accurately assess their location. Thanks to Zortrax 3D printers, creating such highly customized models became possible and economically feasible. They are invaluable during surgical planning since flat images are often insufficient, especially in cases of a bone structure damaged by traffic accidents or oncological procedures.

Goals

All types of eye (orbit) pathologies are particularly challenging for facial reconstruction surgeons.

It is important to recreate the initial shape of the patient’s eye socket to reduce complications such as double vision (diplopia), protrusion of the eye (exophthalmos), displacement of the eyeball (enophthalmos) or deterioration of eye movement. One of the possible ways to reconstruct the floor of the alveolus is to cover the cavity with a network-shaped titanium implant. The implant must be properly shaped to fit the shape of the orbit. The plate must be precisely adjusted to the patient’s anatomy. The most common method was to bend the implant during operation to fit inside the socket floor. But there is a viable alternative to this cumbersome and inaccurate method.

Conclusion Of The Use Of 3D Printing For The Process

Tangible objects are easier to understand than flat images. Step by step, a surgeon can explain each stage of the surgery.

All of the above reduces stress, doubts, and increases the tranquility of patients. Until recently, the inexpensive in-house construction of accurate and intricate medical models was impossible. With 3D printing at hand, specialists have a reliable method for making medical models. Accuracy and speed are unmatched by past methods such as plaster casting or costly mechanical milling. Therefore, 3D printing is the predominant technology in the fields of medicine such as dentistry and orthodontics.