A new orbito-zygomatic complex reconstruction technique using CAD-CAM-assisted harvest of autologous calvarial bone in cases of orbito-zygomatic benign tumor

Publication date: Available online 31 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Romain Nicot, Matthias Schlund, Camille Sentucq, Gwénaël Raoul

Abstract

Purpose

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 due to the necessity of reconstruction of these elements. Autogenous bone is considered to be the gold standard for reconstruction. Nevertheless, the difficulty is related to the complex anatomy and distorted skeletal anatomical 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 orbito-zygomatic complex reconstruction with computer-aided design and manufacturing (CAD-CAM) of autologous calvarial bone.

Materials & Methods: Three cases are presented. After performing the tumor resection using CAD-CAM cutting guides, we used a piezotome to perform osteotomies and preserve the periosteum and sinus mucosa. SinpliciTi system (Materialise, Châtillon, France) allowed us to make cutting guides and a 3-dimensional surgical plan of the shape and the ideal positions for 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 are collected, the shapes can be assembled ex vivo and then put in place through a minimally invasive approach.

Discussion

We discuss the advantages and limitations of our reconstruction method and its place in the management of OZC reconstruction.

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