#5-1. Application in plastic surgery: Reconstruction of the mandible I

Dr. Jung-whan Baek (H Plastic Surgery)

As I have discussed in the previous issue, my interest in rapid prototyping (RP), early 3D printing technology, started with a mock surgery performed prior to mandibular surgery during my residency. And my interest was rekindled in clinical practice when I encountered a patient who suffered facial deformity after excessive mandibular osteotomy. In this article, we will take a look at cases of mandibular reconstructive surgery using 3D printing.

<Image 1> shows the flowchart diagram of reconstructive surgery of the mandible. Bone cement (Poly Methyl Metacrylate; PMMA) was used as the implant material.

Image 1. 3D Flowchart diagram of mandible reconstruction using 3D printing.

Case 1: This patient received sagittal splitting ramus osteotomy (SSRO), chin correction, and mandibular osteotomy due to facial asymmetry. This patient presented severe facial bone asymmetry and indentation due to excessive resection of the gonial angle.

Image 2. The panoramic image shows plates and screws used in SSRO, zygoma reduction, and chin correction. Wires are also visible around the zygoma. This patient had tooth loss and the outline of the denture can also be seen.

Patients with an excess amount of metal in the facial bone have CT artifacts which make 3D CT imaging difficult. And this can compromise surgical precision. Fortunately, the panoramic image shows asymmetric resection of the gonial angle but undamaged bilateral mental nerve. The chin is also asymmetric. For this patient, reconstruction of bilateral gonial angles, chin elongation and angular shaping of the chin for muscular appearance were planned.

Image 3. The post-surgical panoramic image shows that the 3D Fit PMMA implant has a precise fit with the bone structure. The chin asymmetry was also improved with an implant making the chin longer and wider.