Global Experience and Use of CAD-CAM Modeling for Facial Reconstruction

Purpose: Three dimensional (3D) facial analysis and virtual surgical simulation has begun to revolutionize the way surgeons treat and reconstruct head and neck diseases and defects. We evaluated our series of 75 consecutive patients who underwent total Computer-Aided Design and Manufacturing (CAD-CAM) to plan maxillofacial reconstruction including oncologic, orthognathic, congenital and traumatic disorders. We have examined our preoperative plan versus our post-surgical results in order to determine if this new technology improved surgical outcomes.  

Methods: Retrospective chart and image analysis of our global experience with CAD-CAM techniques to treat a variety of reconstructive challenges was performed. Comparisons of 3D scans were performed to examine the virtually created and planned bony alignment to the actual surgical result. We also examined outcomes including dental rehabilitation and TMJ function. All scan results were analyzed using imaging software to assess the positional differences in the bony alignment.  

Results:  The global accuracy of reconstruction was within 3 mm of the targeted goal. Orthognathic results showed all patients reached the desired occlusal alignment.  Between 70 and 80 percent of patients who underwent ablation procedures are either fully dentally reconstructed or are in the process of being reconstructed. Patients undergoing complete joint reconstruction in general have mouth opening ranging from 2 to 4 cm with good function overall.

Summary: Data from 75 patients demonstrates the ability to use this technology to precisely correct myriad disorders including orthognathic deformities, congenital anomalies, traumatic defects, and benign and malignant tumors. CAD-CAM modeling allows for an unparalleled 3D reconstructive accuracy, especially in areas that are difficult to visualize. Preoperative planning and modeling now represents the standard of care for these disorders in our institution.  

Conclusions: CAD-CAM modeling in maxillofacial surgery increases surgical accuracy even in the most complex bony injuries. We also noted improved functional outcomes compared to historic results. CAD-CAM technology allows for unparalleled surgical reliability and dramatically streamlined intraoperative decision making. This technology represents the future of reconstruction for all maxillofacial disorders.

Hirsch DL, Garfein ES, Christensen AM, et al. Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes. J Oral Maxillofac Surg. 2009 Oct;67(10):2115-22.

Tepper OM, Sorice S, Hershman GN, et al. Use of Virtual 3-Dimensional Surgery in Post-Traumatic Craniomaxillofacial Reconstruction. J Oral Maxillofac Surg. 2011, Jan 12.