craniomaxillofacial
case 1: camouflaging of deficient zygomatic prominences by mesh augmentation. a 19-year-old man with a typical-angle class iii appearance is shown preoperatively (fig 4a) and postoperatively (fig 4b). after preoperative planning, a bimaxillary osteotomy with advancement of the upper jaw and backwards movement of the lower jaw following bisagittal split osteotomy was performed. alternative options to augment the malar bone are surgical osteotomy of the malar bone with outwards movement of the zygomatic prominences, high le fort i osteotomy with onepiece movement of the maxilla together with the zygomatic prominence, using other biomaterials than meshes to augment these prominences. in this case, the average prominence in an adult caucasian patient was mimicked by contouring a 0.6 mm thick, 3-D mesh using the artificial skull. Case provided by Nils-Claudius Gellrich, Hannover, Germany
Fig 1 Intraoperative contouring of the 3-D meshes using the sterile artificial skull model.
Fig 2 Two 3-D meshes to the malar prominences, ready to be inserted into the patient and finally individualized in situ before fixation.
a
Fig 3 Postoperative orthopantomogram showing the four-plate fixation of the advanced maxilla and the two-plate fixation after bisagittal split osteotomy in the mandible. Additionally, two meshes are shown in the projection of the malar prominences.
b
Fig 4a–b The patient before (a) and 6 months after (b) bimaxillary surgery, including augmentation of the bilateral malar prominence.
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