Computer-assisted planning of distraction osteogenesis for lower face reconstruction in gunshot traumas

Purpose: Reconstruction of gunshot wounds of the lower face remains a challenge for the maxillofacial surgeon. We present our experience with the use of virtual surgery using Computer-Assisted Design (CAD)/Computer-Assisted Manufacturing (CAM) techniques to create a custom-made distraction device and prefabricated cutting guides (for both fibula and jaw osteotomies) and for device positioning. Materials and methods: We describe two cases of lower face reconstruction after gunshot wounds by osteogenic distraction osteogenesis (DO) and computer-assisted surgery (SurgiCase CMF 5.0 (R) software, Materialise). Surgical osteotomies and placement of the custom-made distraction device were performed intraoperatively based on prefabricated guides. Results: This fully digital preoperative planning improves the precision of osteotomies sites and distraction vectors. It largely reduces the operative time, with a greater operative safety. Conclusions: Reconstruction by DO allows the bone and soft tissues to be simultaneously regenerated. However, the control of three-dimensional reconstruction of the lower face with distraction is difficult in facial gunshot patients because of the difficulties in locating anatomical landmarks. Surgical osteotomies are pre-planned and rapidly performed using a cutting guide. Precise placement of the distraction device is achieved without the need for subjective assessment of the sole surgeon. In our experience, the surgery has resulted in outcomes similar to those predicted by the computer-assisted planning. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.