EFFICACY OF THE 3D TECHNOLOGIES IN A TREATMENT OF THE POSTTRAUMATIC ZIGOMA DEFORMITIES

Chepurnyi Y., Chernogorskyi D., Zhukovtseva O., Kopchak A.

METHODS AND METHODOLOGIES

Scentific article

Elimination of facial disfigurement, caused by the posttraumatical deformities of the zigomaticalmaxillary complex is an actual problem of the maxilla-facial surgery. Zigoma plays a crucial role in a formation of the horizontal symmetry of the face, so its reconstruction should be the key point of the surgical treatment. Imbalance of this facial asymmetry may lead to deficit of the patient’s medical-social adaptation. The treatment of the zigoma deformities consist of osteotomy performance with following reduction and fixation. In some cases, bone grafting procedures or reshaping with implant application is required. However, correct positioning of the zigoma can be challenging, due to remodelling of the bone fragments especially near the contact surfaces. This determinate the incorrect reduction of the zigoma during surgery. Application of the 3D technologies in medicine have changed principals of the facial trauma management. Guided surgery became a new approach in a facial fracture treatment. The main goal of the guided surgery is determination of the bone fragment or implant position during surgery, based on presurgical virtual planning. The aim of this study was to defined a protocol of the clinical application of the positional surgical guide for zigoma. Object and methods. Sixteen patients were enrolled into this study (11 males and 5 females), with mean age 37,3±14,7 years (18 to 70). All patients were evaluated according standard clinical protocol with CT examination before and after surgery. Virtual planning and computer assisted design of the positional surgical guides were performed into virtual software environment with following computer additive manufacturing by FDM or SLS printing. During surgery just after osteotomy, guide was fixed to the undamaged facial bones by screws and further positioning of the zigoma according guide’s internal surface were performed. Than zigoma was fixed by conventional plates or patient specific implants. Accuracy of the reduction were performed with application of the “point-topoint” registration method with determination of the maximum and mean deviation values comparing presurgical planning, mirrored opposite side and postsurgical outcome. Results and conclusions. Application of the positional surgical guides in management of the zigoma deformities allow to provide precise zigoma reduction. Mean deviation between opposite side mirrored and reconstructed zigoma was 1,4±0,3 mm. This approach is characterized by the high reproducibility of the planned result mean deviation between pre-planned result and surgical outcome was 1,1±0,4 mm.

zigoma deformities, pacient specific implants, guided surgery

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«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 216-222 pages, index UDK 616.76–001.4–06:617.764.2–089.844

10.29254/2077-4214-2020-2-156-216-222