The Importance of Using Physical Tridimensional Models for the Management and Planning of Extended Osseous Odontogenic Lesions

(1) Surgical intervention becomes crucial in situations in which lack of action would cause a decrease in quality of life for the patient. As healthcare professionals, our next objective is to reduce patient fear perception. This work’s aim is to illustrate how physical tridimensional models can serve not only as confidence boosters for the patient, but also as a valid tool to aid both the clinician and the fostering of a patient–doctor relationship. (2) An example case managed using a stereolithographic model in the pre-surgical planning stage is presented in which surgical planning was carried out by analysis of radiographic investigations combined with a tridimensional resin model derived from the patient’s x-ray exam. (3) Successful enucleation, surgical debridement, and stable follow-up shows the effectiveness of the applied surgical protocol, confirming that planification using a physical representation of the tridimensional exam aids in the correct surgical management of said lesions. (4) The effectiveness o101f the surgical act itself as well as the follow-up showing ossification of the bony lesion and absence of relapse of a highly recurrent lesion confirms the effectiveness of the tools used for this surgical intervention.

Reconstruction of extensive sequel of frontal fracture: optimizing results

Introduction: Fractures of the frontal bone correspond to 5 to 15% of all facial fractures. This type of fracture can lead to difficulties in restoring bone congruence and to postoperative secondary aesthetic problems. Objective: This paper aims to present a clinical case report of frontal bone fracture where a late reconstruction was performed using a titanium mesh with the aid of stereolithographic model prototyping. Case report: Female patient, 26 years old, with aesthetic sequelae in the upper third of the face after a motorcycle accident. The imaging exams showed a comminuted frontal bone fracture, as well as upper edge and right orbit ceiling involvement. The planning consisted of reconstruction of the affected area with the use of a titanium mesh pre-shaped in a stereolithographic model. The procedure was performed under general anesthesia and coronal access. After installation of the fixation material, pericranial flap rotation and suture of the surgical wound were performed. The patient progressed well, with considerable improvement in facial aesthetics. Conclusion: This paper reports the importance of good planning in cases of frontal bone fracture sequel, in which the use of model-shaped mesh in a stereolithographic model tends to optimize surgery, bringing aesthetic and psychosocial benefits. Keywords Frontal bone; Titanium; Craniocerebral trauma.

Reconstruction of Congenital Arhinia With Stereolithographic Modeling: Case Correlate and Literature Review

Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and airway. We report our novel multistaged reconstructive approach and literature review. Nasal methyl methacrylate prosthesis was created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 with cannulization was utilized for midface advancement and airway formation. External framework was reconstructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. Patient was pleased with the aesthetics and had safe decannulation with the ability to breathe through the nose and airway.

EXTERNAL AUDITORY MEATUS: LANDMARK FOR V OSETOTOMIES IN SQUARE FACE CORRECTION: A TECHNICAL NOTE

The authors present a new technique for planning of V-osteotomies in correction of square face. A static bony landmark: External acoustic meatus (EAM) is used for planning the osteotomy cuts on stereolithographic model which provides accurate replication of planned osteotomy cuts on table.

A Preshaped Titanium Mesh for Guided Bone Regeneration with an Equine-Derived Bone Graft in a Posterior Mandibular Bone Defect: A Case Report

One of the most often used bone augmentation techniques is the guided bone regeneration procedure. The authors report the case of a 75-year-old man with an atrophic right posterior mandible who underwent bone augmentation through guided bone regeneration with a preshaped titanium mesh adapted on a stereolithographic model of the patient’s jaw. The graft volume was simulated with a light-curing resin. The actual site was grafted with a mixture of autogenous and equine-derived bone. Five months later, the mesh was retrieved, three cylindrical implants were positioned, and a bone biopsy was collected for histomorphometric analysis. A provisional prosthesis was delivered three and a half months later. Definitive rehabilitation was accomplished after one additional month. The graft allowed for effective bone formation (newly formed bone, residual biomaterial, and medullar spaces were, respectively, 39%, 10%, and 51% of the core volume). The patient has functioned successfully throughout six and a half years of follow-up. Using the preshaped titanium mesh in association with the enzyme-treated equine bone substitute provided effective bone regeneration.

Removal of a Frontal Sinus Osteoma and Reconstruction by a Custom-Made Implant with Neuronavigation Assistance

The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan showed a very large bony mass involving right frontal sinus and displacing the orbital roof. A stereolithographic model–guided planning was carried out to obtain a practical simulation of the surgical operation and it was submitted to a new CT scan to acquire the reference point to realize the neuronavigation assistance, and to achieve the template to realize the hydroxyapatite custom-made implant. Intraoperatively, with the help of neuronavigation assistance, osteotomies were performed by piezoelectric device. The reconstruction was made using a hydroxyapatite custom-made implant. The procedure was damage free, the bony mass was excised, and the orbital roof was repaired without any adverse effects. Postsurgical CT scan and scintigraphy showed a good reconstruction and a good-quality osteoblasts activity on the borders of the implant. Osteoma is a benign slow-growing bone tumor, usually involving the frontal sinus. Navigational assistance offers a very important help to perform safe osteotomies. Hydroxyapatite custom-made implant seems to be an excellent reconstructive method.

New Management in Bilateral Masseter Muscle Hypertrophy

Bilateral masseter muscle hypertrophy is an alteration in shape and thickness of the masseter muscles that can modify the width of the lower face causing aesthetic and functional problems. A 21-year-old man was referred to the Department of Maxillofacial Surgery at the Civil Hospital in Brescia by his dentist for an evaluation of his facial appearance with a square-face type. To reduce the undesirable facial appearance, a surgical intraoral approach was performed; the procedure includes the bilateral dissection of the masseter muscle, partial lipectomy, and the ostectomy of the mandibular angle assisted by a surgical guide built on a stereolithographic model. The patient was satisfied with the functional and aesthetic outcomes of both the profile and the frontal views. There was no evidence of complication at a 1-year follow-up. This new method yields optimal aesthetic results with an enhanced outline of the lower face.