Sterile Artificial Skull

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Sterile Artificial Skull

Fig 1 Sterile artificial skull model.

The new artificial sterilizable skull is the first autoclavable, one-piece human skull model intended for aiding initial plate contouring in the operating room, and for visualizing facial structures.

There is a need for sterile artificial skulls for any craniomaxillofacial (CMF) surgeon who provides CMF reconstructions. The clinical reality is that surgeons worldwide have individual methods to address this need due to the difficulty and lack of anatomical reference points in cases with large bone defects. However, the skull model needs to be mechanically strong for intraoperative contouring of plates, meshes, and biomaterials.

The patients anatomy is essential for a proper and adequate reconstruction of the defects. Improper contouring of the plates may lead to complications resulting in functional and/or aesthetic problems that require secondary surgery.

Details
Clinical Cases
Disclaimer

This sterile artificial skull model is an approximation of the average craniofacial anatomy, originating from data from up to 2000 analyzed CT scans. These scans were used to develop the matrix midface preformed orbital plates and the matrix mandible preformed reconstruction plates (Fig 2), launched in 2008 and 2009, respectively. The manufacturing material is polyphenylsulphone, which allows the skull to be steam sterilizable, reusable, cleanable, and biocompatible.

This new productthe sterile artificial skullcontributes to a more appropriate hard-tissue reconstruction in the CMF region, especially in cases of trauma, tumor, and craniofacial deformity. It provides a unique aid, always available and ready to use even in emergency cases.

Fig 2 Matrix mandible preformed reconstruction plate contoured using the sterile artificial skull.

Case 1: Camouflaging of deficient zygomatic prominences by mesh augmentation. a 19-year-old man with a typical-angle class iii appearance is shown preoperatively (fig 4a) and postoperatively (fig 4b). after preoperative planning, a bimaxillary osteotomy with advancement of the upper jaw and backwards movement of the lower jaw following bisagittal split osteotomy was performed. alternative options to augment the malar bone are surgical osteotomy of the malar bone with outwards movement of the zygomatic prominences, high le fort i osteotomy with onepiece movement of the maxilla together with the zygomatic prominence, using other biomaterials than meshes to augment these prominences. in this case, the average prominence in an adult caucasian patient was mimicked by contouring a 0.6 mm thick, 3-D mesh using the artificial skull.

Case provided by Nils-Claudius Gellrich, Hannover, Germany

Fig 1 (left) Intraoperative contouring of the 3-D meshes using the sterile artificial skull model. Fig 2 (right) Two 3-D meshes to the malar prominences, ready to be inserted into the patient and finally individualized in situ before fixation.

Fig 3 Postoperative orthopantomogram showing the four-plate fixation of the advanced maxilla and the two-plate fixation after bisagittal split osteotomy in the mandible. Additionally, two meshes are shown in the projection of the malar prominences.

Fig 4ab The patient before (a) and 6 months after (b) bimaxillary surgery, including augmentation of the bilateral malar prominence.

Case 2: A 19-year-old woman had an extended sinunasal carcinoma in the right maxillary sinus area. fig 2 shows four views of the virtual preplanned computer-aided design; the reconstruction is represented in pink (fig 2a). The three remaining multiplanar views show the overlapping images of the virtual preplanned reconstruction (pink) and reconstruction result performed by using two individualized 3-D meshes (one for a three-wall-reconstruction of the orbit and one for reconstructing the right midfacial prominences).

Cases provided by Nils-Claudius Gellrich, Hannover, Germany

Fig 1ab Through a modified transfacial approach (without additional infraorbital or transconjunctival release incision) the two prebent meshes are shown in situ after final in situ individualization using intraoperative navigation. Screw fixation is mandatory to allow for secure positioning of the meshes.

Fig 2ad Intraoperative view of the result of the sterile moulding of a 1.3 mm orbital fan plate to reconstruct three orbital walls, ie, medial wall, orbital floor, and lateral wall of the right orbit plus the 0.6 mm 3-D mesh to reconstruct the paranasal pillar, right nasal bones, infraorbital rim, lower part of the la

Fig 3 Three-dimensional mesh is preformed using an artificial sterilized skull to camouflage the temporal region. Prior to radiotherapy, a reentry via a coronal approach was performed in the patient to adequately wrap the individualized 3-D meshes with vital soft tissues, by performing an ipsilateral temporalis flap. T

Fig 4 Postoperative CT scan after temporalis flap is made and correction of the temporal contour using the 3-D mesh shown in Fig 3. In the right nasoorbitoethmoidal area a plate can be identified which allows an appropriate reposition of the medial canthal ligament by using a cantilever (Hammer) technique.

Fig 5 Postoperative image of coronal approach. A stealth incision was used without additional shaving. Wound closure is provided with staples which can be easily removed 10 days later.

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