Current Advances in Complex Craniofacial Recontouring

Introduction: Complex craniofacial reconstructions require precise planning and a combination of various treatment options to result in a favorable input to output ratio.

Material and Methods: We present the latest advances in the combination of software modifications for virtual model planning with intraoperative navigation and application of specific orbital mesh types and bone substitutes or autologous bone grafts to reconstruct extended contour defects of the craniofacial skeleton.

Results: In 17 patients with craniofacial deformities involving at least the upper and middle thirds of the skull, the above-mentioned multimodal therapeutic concept was carried out. Except for 4 cases, all were performed as single surgeries instead of multiple operations. In 3 cases, individual CAD/CAM titanium implants were contoured according to the virtually optimally reconstructed anatomy and simultaneously intraoperatively inserted, whereas the neighboring augmented contours (via reosteotomy and repositioning, bone grafting, bone substitute, mesh) were controlled via navigation. The latter 3 patients underwent extended craniofacial trauma with primary dural reconstruction. Secondarily, the above-mentioned reconstruction was performed as a single-step procedure. Simultaneous camouflaging of temporal hollowing was required in 2 of these patients by replacing soft tissue loss through hard tissue augmentation. Advanced analyzing software was used to validate the surgical outcome in comparison to applied measures.

Conclusions: Current research and future perspectives include autologous tissue-engineered reconstruction to avoid additional split bone graft harvesting and to achieve a more biological type of reconstruction. This is the focus of the interdisciplinary research cooperation between material research people and head specialties.