Rapid prototyping in craniofacial surgery: Using a positioning guide after zygomatic osteotomy – A case report

IntroductionThe management of post-traumatic deformity in the midface region poses challenges for the maxillofacial surgeon. Ensuring symmetry after zygomatic osteotomy can be difficult and precise positioning of the osteotomised bony fragments requires careful treatment planning. It may be necessary to use a coronal flap to allow the surgeon to compare the contralateral zygomatic bone to allow symmetrical reduction.The authors present a new technique for the positioning of osteotomised zygomatic bones using a combination of computer assisted surgical simulation and rapid prototyping.MethodA patient presented to our unit with a post-traumatic zygomatic deformity. Using surgical simulation software the displaced zygomatic bone was osteotomised and placed in the idéal position on a three-dimensional computed tomography scan (3D CT). The position was determined by reference to the contralateral zygoma. In addition the repositioning of the soft tissues was simulated.A surgical guide which allowed intraoperative positioning of the osteotomised zygoma was manufactured by a rapid prototyping process. Use of the guide allowed a minimally invasive approach to the affected zygoma. The post-operative results were compared to the predicted outcome.ResultsThe post-operative appearance was satisfactory and corresponded well with the predicted result. There was a significant reduction in operative time compared to the previous management of similar cases.