(FIGURE 1) Coronal and axial CT images of a 19-year-old man with multiple periorbital fractures and significant comminution and misalignment
of bones following a gun shot to the right face.
(FIGURE 2) The CT of the patient is uploaded to create a 3-D computerized representation of the bone fragments with the bone fragments highlighted in purple.
(FIGURE 3) The bone fragments are then virtually realigned in this 3-D representation and custom templates are designed to reproduce the natural contours of the desired reduction.
(FIGURE 4) (top)
A 3-D model of the reconstructed facial skeleton, with bone fragments realigned in their ideal locations,
is printed using a 3-D printer. Missing bone
of the right cheek and inferior orbital rim is demonstrated.
(bottom) Polyamide guides are also 3-D printed for intraoperative use.
(FIGURE 5) The polyamide guides are sterilized and placed over fracture lines intraoperatively to ensure proper alignment of fracture fragments in 3-D.
(FIGURE 6) Anticipated bony defect of right inferior orbital rim corrected with porous polyethylene implant.
(FIGURE 7) Postoperative CT images showing excellent symmetry and alignment.
(Images courtesy of Paul Langer, MD)
(Images courtesy of Paul Langer, MD)