Dr. Jung-whan Baek (H Plastic Surgery)

 

In this article, we will take a look at Korea’s very first case of zygoma reconstruction using a customized titanium zygoma implant produced by 3D printing.​ Zygoma reconstruction differs from mandibular reconstruction. The biggest difference is that the three-dimensional structure of the bone defect is a lot more complicated than that of mandible and the final outcome of the surgery also differs greatly between individuals. The external changes resulting from reconstructive surgery are more prominent in zygoma than in mandible. In other words, the final external outcome resulting from the implant is more subtle in the mandible compared zygoma. 

 

Changes in zygoma are more detailed and visually reflected in the resulting external appearance. For this reason, more caution and considerations should be given in fabrication of the implant for zygoma reconstruction. This means there are more variables to consider during pre-surgical simulations as well as during surgery. The angle in which the implant is inserted also limits its shape and a multi-piece implant may be required depending on the defect. In this article, we will discuss limitations of traditional reconstructive techniques and use of 3D printed titanium implant in a case of post-traumatic zygoma deformity.

 

Image 1. Pre-surgery 3D CT.

 

Pre-surgery 3D CT shows a mesh-type implant in the right zygoma (Image 1). The mesh implant was used to correct the bone defect, deformity and indentation of the zygoma body arising from lack of treatment after the initial traumatic damage. The indentation was covered with a mesh but the physical defect was not corrected. Asymmetry caused by bone deformity was not resolved either. Materials used in traditional reconstructive surgery cannot completely restore the normal volume or reflect the complicated structure. 

 

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Image 2. Isolated 3D CT image of zygoma.

 

<Image 2> shows the mesh implant, area of defect, and asymmetry arising from bone deformity. The area marked in blue in the right image shows the protrusion caused by bone union after the fractured zygomatic arch migrated toward the temporal bone. The area marked in red shows the asymmetry caused by inferio-medial deformation of zygomatic arch. The customized 3D implant should be designed to fit the area of defect after surgical removal of the mesh. However, this requires two separate surgeries which will cause excessive pain to the patient. Therefore, I performed a virtual removal of the mesh implant using a software and planned fabrication of customized 3D titanium implant. 

 

-To be continued

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