Advertisement

Facial Skeletal Augmentation Using Custom Facial Implants

      Facial skeletal augmentation is one of many techniques used to enhance facial aesthetics. It is especially useful in the malar, mandibular angle, and genial areas. For many years, correction of facial contour deformities posed challenges for reconstructive surgeons. Two-dimensional radiographic and photographic imaging modalities provided limited diagnostic and treatment planning information. An arduous procedure could be undertaken to take a facial impression and create a stone facial model of the facial soft tissues. This three-dimensional (3D) model simulated the patient’s face but provided no information on the underlying bony contours. The surgeon primarily used their artistic ability to diagnose and treat facial contour deformities. Treatment was limited to the use of stock implants that were placed as is or altered at the time of surgery. With the more widespread use of computed tomography (CT) in the 1980s, 3D representations of the patient’s facial skeletal anatomy became available. Computer technology has advanced to allow an accurate duplication of a patient’s facial skeletal and soft tissue anatomy. According to Winder and Bibb, medical rapid prototyping is defined as the manufacture of dimensionally accurate physical models of human anatomy derived from medical image data [
      • Winder J.
      • Bibb R.
      Medical rapid prototyping technologies: state of the art and current limitations for applications in oral and maxillofacial surgery.
      ]. This technology was originally described by Mankowich and colleagues in 1990 [
      • Mankovich N.J.
      • Cheeseman A.M.
      • Stoker N.G.
      The display of three-dimensional anatomy with stereolithographic models.
      ]. With the use of this technology, the ability to manufacture or fabricate custom craniofacial implants has evolved.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      References

        • Winder J.
        • Bibb R.
        Medical rapid prototyping technologies: state of the art and current limitations for applications in oral and maxillofacial surgery.
        J Oral Maxillofac Surg. 2005; 63: 1006-1015
        • Mankovich N.J.
        • Cheeseman A.M.
        • Stoker N.G.
        The display of three-dimensional anatomy with stereolithographic models.
        J Digit Imaging. 1990; 3: 200
        • Binder W.J.
        Custom designed facial implants.
        Facial Plast Surg Clin North Am. 2008; 16: 133-146
        • Binder W.J.
        • Kaye A.
        Reconstruction of posttraumatic and congenital facial deformities with three dimensional computer-assisted custom designed implants.
        Plast Reconstr Surg. 1994; 94: 775-785
        • Zim S.
        Skeletal volume enhancement: implants and osteotomies.
        Curr Opin Otolaryngol Head Neck Surg. 2004; 12: 349-356
        • Ludlow J.B.
        • Ivanovic M.
        Comparative dosimetry of dental CBCT devices and 64 slice CT for oral and maxillofacial radiology.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: 106-114
        • Loubele M.
        • Maes F.
        • Jacobs R.
        • et al.
        Comparative study of image quality for MSCT and CBCT scanners for dentomaxillofacial radiology applications.
        Radiat Prot Dosimetry. 2008; 129: 222-226
        • Loubele M.
        • Bogaerts R.
        • Van Dijck E.
        • et al.
        Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications.
        Eur J Radiol. 2009; 71: 461-468
        • Benazzi S.
        • Sascha S.
        Comparing 3-dimensional virtual methods for reconstruction in craniomaxillofacial surgery.
        J Oral Maxillofac Surg. 2011; 69: 1184-1194
        • Karras S.
        • Wolford L.
        Augmentation genioplasty with hard tissue replacement implants.
        J Oral Maxillofac Surg. 1998; 56: 549-552
        • Eppley B.L.
        • Sadove A.M.
        • Holmstrom H.
        • et al.
        HTR® polymer facial implants: a five year clinical experience.
        Aesthetic Plast Surg. 1995; 19: 445-450
        • Gui L.
        • Huang L.
        • Zhang Z.
        Genioplasty and chin augmentation with Medpore implants: a report of 650 cases.
        Aesthetic Plast Surg. 2008; 32: 220-226
        • Yaremchuk M.J.
        Facial skeletal reconstruction using porous polyethylene implants.
        Plast Reconstr Surg. 2003; 111: 1118-1827
        • Constantinides M.S.
        • Galli S.K.
        • Miller P.J.
        • et al.
        Malar, submalar, and midfacial implants.
        Facial Plast Surg. 2000; 16: 35-44
        • Kim M.M.
        • Boahene K.D.
        • Byrne P.J.
        Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects.
        Arch Facial Plast Surg. 2009; 11: 53-55
      1. Communication with Synthes CMF®. West Chester (PA). Available at: www.synthes.com. Accessed July 16, 2011.

        • Keefe M.S.
        • Keefe M.A.
        An evaluation of the effectiveness of different techniques for intraoperative infiltration of antibiotics into alloplastic implants for use in facial reconstruction.
        Arch Facial Plast Surg. 2009; 11: 246-251
        • Niamtu J.
        Essentials of cheek and midface implants.
        J Oral Maxillofac Surg. 2010; 68: 1420-1429
        • Metzinger S.E.
        • McCollough G.
        • Campbell J.P.
        • et al.
        Malar augmentation: a 5-year retrospective review of the silastic midfacial malar implant.
        Arch Otolaryngol Head Neck Surg. 1999; 125: 980-987
        • Powell N.B.
        • Riley R.W.
        • Lamb D.R.
        A new approach to evaluation and surgery of the malar complex.
        Ann Plast Surg. 1988; 20: 206-214
        • Hinderer U.
        Profilplasty.
        Int Macro J Aesthic Plast Surg. 1971; 1: 12
        • Arnett G.W.
        • Bergman R.T.
        Facial keys to orthodontic diagnosis and treatment planning–part I.
        Am J Orthod Dentofacial Orthop. 1993; 103: 299-312
        • Arnett G.W.
        • Bergman R.T.
        Facial keys to orthodontic diagnosis and treatment planning–part II.
        Am J Orthod Dentofacial Orthop. 1993; 103: 395-411
        • Scheideman G.B.
        • Bell W.H.
        • Legan H.L.
        • et al.
        Cephalometric analysis of dentofacial normals.
        Am J Orthod. 1980; 78: 404-420
        • Spradley F.L.
        • Jacobs J.D.
        • Crowe D.P.
        Assessment of the anteroposterior soft tissue contour of the lower facial third in the ideal young adult.
        Am J Orthod. 1981; 79: 316-325
        • Burstone C.J.
        Lip posture and its significance in treatment planning.
        Am J Orthod. 1967; 53: 262-284