Computer-Aided Reconstruction of Traumatic Fronto-Orbital Osseous Defects: Aesthetic Considerations

Background: In addition to functional goals, a satisfactory aesthetic outcome is important for reconstruction of fronto-orbital osseous defects. The purpose of this study is to report on a method for presurgical fabrication of custom implants using 3-dimensional (3-D) imaging data and computer-assisted manufacturing techniques. Methods: Preoperative 3-D computed tomography data were processed and displayed for evaluation of defects. Implants were created by a computer-aided design/computer-aided manufacturing (CAD/CAM) program. A rapid proto-typing system was applied for production of the physical models. Rehearsal of surgery was performed using the implants and skull models. Negative castings were created and were used during the operations to prepare the sur-gical implant utilizing methyl methacrylate. Traumatic fronto-orbital defects in 4 patients were reconstructed using this method. The follow-up period ranged from 29 to 55 months. Results: Results showed that the custom implants perfectly fit the defects during the operation. Symmetry and normal fronto-orbital contours were achieved. There were no peri- or postoperative complications. All patients were satis-fied with the results. Conclusions: Computer-aided presurgical simulation and fabrication of implants is a reli-able and effective method for the reconstruction of traumatic fronto-orbital defects, with reduced anesthesia time and improved aesthetic outcomes. (Chang Gung Med J 2004;27:283-91) Key words: fronto-orbital defect, computer-aided reconstruction, custom implant, rapid proto