Surgical planning using facial fracture 3D models: The role of cyanoacrylate glue and miniplating for anatomical reduction

BACKGROUND: In comminuted facial fractures, peri-operative use of 3D-printed life size models is increasingly a useful adjunct. It allows for preoperative surgical rehearsal and plate bending, to achieve anatomical reduction with reduced operative time and cost. One problem encountered is difficulty contouring the fixation plate whilst maintaining the relative spatial orientation of comminuted fragments. This paper shares an effective method of overcoming this problem. METHODS: All comminuted facial fracture patients underwent counselling for 3D printing. Pre-printing thresholding and segmentation of each fragment (as directed by the surgeon) were done by the radiologist and the engineering team, using the multi-slice CT Face DICOM data. Life-size 3D-resin models of the fractures were printed. Fast-acting medium consistency cyanoacrylate glue (Zap-A-Gap(Ⓡ)) and miniplates were used to assemble the printed model segments in ‘anatomic reduction’. Aerosolized alcohol accelerator facilitated immediate glue curing, providing a stable model. The plates were adapted over this restored neonative 3D construct with bending inserts, sterilized and used intraoperatively. The 3D model was used to guide the operative sequence. Intraoperative CT was used in select cases to confirm anatomic reduction. RESULTS/COMPLICATIONS: All patients (n = 5) had comminuted fractures in at least one of the bony units (mandible, maxilla or orbits) and one was a pan-facial fracture case. 3D printed models aided fracture reduction and fixation, whilst avoiding the guesswork in ascertaining the contour of the mandibular arch. In addition, the pre-contoured mandible plates restored premorbid occlusion and projection, without the need for long-term archbars in all cases. Operative time was estimated to be reduced by 0.5–1 h. Resident teaching was enhanced by this approach. CONCLUSION: The application of medium consistency fast-acting cyanoacrylate glue and miniplates facilitated the creation of the premorbid facial skeletal model and allowed pre-bending of the plates, thus saving operative time and cost.