Acrylic frontal cranioplasty using 3d ct data and stereolithography: Case report

Adult patients with cranio-orbital defects or anomalies secondary to neonatal surgery for craniofacial malformations, still come to our attention for evaluation. Often onlay grafts or implants are the best "camouflage" option. Autologous bone and different types of alloplastic materials are widely used. Autologous bone may be reabsorbed in unpredictable percentages; therefore it is not always indicated in smooth and curved areas such as the forehead. Acrylic implants are a common method of restoring cranial bone, giving excellent mechanical protection and stability. Secondary cranioplasty was performed on an adult female patient presenting fronto-orbital bone dismorphology. The patient was born with a non syndromic brachycephaly and operated on elsewhere in infancy by fronto-orbital advancement. The lower forehead, orbital ridges, glabella and nasal root were retruding, while the upper forehead was asymmetrically protruding. Bone surface was irregular. No full thickness defects were detected by CT scan. Computed tomography data were utilised to produce, by stereolithography, a plastic model of her skull. A wax template on the plastic model was then handmade and an acrylic custom implant was fabricated, exactly reproducing the template. In the first surgical step a forehead skin expander was inserted in order to have abundant skin available later. During the second surgical procedure, the prefabricated implant was inserted. As planned the fit was perfect. Furthermore some wires secured the implant to the surrounding frontal bone. The expanded skin allowed a tension-free suture. The postoperative course was uneventful. Long-term follow-up showed excellent and stable results. Customization and prefabrication of implants reduce operating time and improve cosmetic results. A more precise morphological shaping of such a difficult cranial area as the forehead is also permitted. High costs of computer devices and stereolithography are widely compensated for by a significant decrease in operating time and morbidity. This type of procedure can be very effective in selected extracranial cranioplasties.