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Surgical Technique |

Image-Guided Titanium Implantation for Craniofacial Prosthetics

Noah E. Meltzer, MD; Juan R. Garcia, MA; Patrick J. Byrne, MD; Derek K. Boahene, MD
Arch Facial Plast Surg. 2009;11(1):58-61. doi:10.1001/archfacial.2008.510.
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Osseointegration implants have revolutionized craniofacial prosthetic reconstruction. Implant placement relies on adequate thickness and quality of bone to permit osseointegration. Positioning the implant is critical in craniofacial reconstruction because surface contours of the prosthesis must be preserved while housing attachment components securely and discreetly. Also, the position of the final prosthesis must transition to native tissue smoothly. We report on the use of intraoperative stereotactic image guidance in the placement of implants for orbital, nasal, and auricular prosthetic reconstruction. Clinical data, intraoperative images, and postoperative rehabilitated results are presented to demonstrate the utility of the application of stereotactic image guidance for implant placement. In our experience, stereotactic image guidance facilitates optimal implant site selection if there is abnormal bone quantity or quality.

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Figure 1.

Auricular prosthetic reconstruction. A, With the head frame in place, the height of the contralateral ear and a surface model slotted at the positions of greatest lateral prosthesis projection are used with the blunt planar probe to identify optimal implant locations. B, Healing covers are placed after the position of the implants correlates with skin marks in A. C, With the foundation in place, a cantilevered inferior extension was required, even though the most inferior dysplastic mastoid tip bone was implanted. D, Prosthesis in place.

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Figure 2.

Nasal prosthetic reconstruction. A, Total rhinectomy patient after implantation. With the use of image guidance it was possible to place the anterior nasal sidewall implant without obstructing the nasolacrimal duct. B, The lateral implant was used as a base for support in the coronal plane. C, Prosthesis fitting trial. Note sufficient stability to support eyeglasses.

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Figure 3.

Orbital prosthetic reconstruction. A, Orbital exenteration patient presented for revision implantation after irradiation and implant loss. The most anterior implant and the implant just posterior were placed in bone sufficiently thick to avoid the frontal sinus and the anterior cranial fossa. B, Technovent magnacap magnetic attachments (Technovent Inc, Leeds, England) are placed. C, The prosthesis is held in place by the 2 anterior magnetic attachments.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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