Applications in Surgery
Within eight years, we had 331 model cases, 77% maxillofacial cases being the vast majority (most of them congenital malformations and tumor defects, along with trauma defects). 12% were skull defects, and 11% orthopedic cases (7% pelvis, and 4% other, such as spine and extremities).
Applications in Maxillofacial Surgery
Case: Massive mandibulatory defect
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11-year-old girl |
At age eleven, this girl was presented at our clinic, having received surgery in early childhood (tumor removal; presumably giant cell granuloma).
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| Milling model; different views. Right: Surgery planning. | ||
A milling model was produced. Note that the orbits, being unimportant in this case, were not
rendered. Fixing the defect of the mandibula with a graft from the pelvic crest was planned
and performed.
In maxillofacial cases, it has become common practice that rather than using the
teeth of the model, the surgeon places a cast of them on the model.
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| At age 11 and 13. | |
Lateral view at age eleven (prior to surgery) and thirteen (post surgical result).
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At age 18. |
At age 18, the result is quite satisfactory (teeth implants for the mandibula are being planned).
Applications in Craniofacial Surgery
Case: Pfeiffer syndrome
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| Three-month-old girl; x-ray. | ||
At three months, this child was presented at our clinic, suffering from synostosis of the coronal suture due to Pfeiffer syndrome.
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At age one. |
At age one, the forehead shows the typical shape afflicted with this type of synostosis
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Surface rendering of volume CT data. |
At age two, volume CT data with respect to model production was aquired. Surface rendering shows the anatomical situation.
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| Milling model for surgery planning (model was split into half shells).
Right: front of skull temporarily removed during surgery, cut according to the model. |
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The milling model was utilized for surgery planning; frontal advancement was performed. Note the corresponding parts in both model and front of skull.
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| Prior to surgery; post-surgical result. | |
The result is good.
Case: Crouzon's syndrome
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| Girl aged three months. X-ray, Surface rendering of volume CT data. | ||
Three month old child with typical kleeblattschadel, showing hammered brass appearance of the calvarium.
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| Models. | ||
A stereolithography and two milling models were produced; one milling model of the complete skull, omitting its inside, and, for surgical planning, two half shells along with the mandibula.
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| Prior to surgery, post-surgical result. | |
The shape of the skull was restored to normal.
Applications in Orthopedic Surgery
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Milling model of a pelvis for endoprosthesis customizing. |
A wide area in orthopedic surgery with the need for models is the field of endoprosthetics. The patient's pelvis is modeled so that the surgeon can customize a prosthesis for the patient.
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| Implant fitted to model; during surgery. | |
Nowadays it is also possible to omit pelvis reconstruction by model entirely; instead the volume data is used to construct the implants directly.
Case: Congenital scoliosis
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| MIP (maximum intensity projection), sagittal view;
MPR (multiplanar reconstruction) across T11. |
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2 year old child with severe congenital scoliosis, due to hemivertebrae T10, T11, and T12 (pictured: lateral view of a maximum intensity projection, based on CT volume data).
The axial slices did not yield immediate information on the anatomical situation.
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| 3D reconstruction of the spine and the vertebrae. | |
First, we did a 3D reconstruction (surface rendering), color-coding the vertebrae and mapping them separately.
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| Model; X-ray: surgical result. | |
A milling model was produced.
The scoliosis was then corrected, using an autologous fibula graft.
The result of the surgery in the lateral view is rather impressive.
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