Usefulness of customized titanium plates for midface contouring surgery

INTRODUCTION AND IMPORTANCE: In our department, we have been performing bone reconstructions on a case-by-case basis using vascularized free tissue transfers and custom-made artificial bones (HA). While these procedures have specific advantages, they are also limited in terms of the invasiveness as well as the stability and strength of implants. In the present study, we describe the use of a CTP to achieve minimally invasive midface plastic surgery with the superior moldability of a 3D structure and reliable stability compared to the use of autologous tissue. CASE PRESENTATION: A total of three patients were included in the study. The patients (all female, ages: 66, 18, and 35 years) had bone malformation or hemifacial microsomia following surgery for maxillary cancer or multiple facial fractures. Based on DICOM data from preoperative CT, 3D models were created on a computer using CAD/CAM techniques. The models were compared in simulations to determine the optimal structure. These 3D models were used in additive manufacturing systems to create custom-made titanium alloy plates for facial reconstruction. CLINICAL DISCUSSION: Although the amount of soft tissue was insufficient in some cases, all patients were able to maintain the desired morphology without developing any complications such as infections, significant soft tissue atrophy, or implant failure. CONCLUSION: Our CTP model created by CAD/CAM was effective in contouring surgery of the midface as it had the superior stability and biocompatibility of titanium. Changes to the soft tissue should also be considered in order to further improve the procedure.