CAD-CAM Modeling for Craniofacial

Surgery
Surgeons at Penn Medicine are using computer-aided design and manufacturing
(CAD-CAM) programs to create custom-designed cutting and placement guides for
preoperative planning and bone positioning during reconstructive surgery for complex
craniofacial malformations.

CAD-CAM procedures use computed tomography (CT) data to generate anatomically

accurate three-dimensional (3D) models of the patient’s bone structure, permitting
cephalometric assessment of traumatic and pathological defects prior to surgery.
These renderings can be used to fabricate guides for both the early resection process
and the later precise placement of bone for fixation during surgery and/or custom
prosthetic implants.

CAD-CAM templates are precise to within 1 mm, resulting in faster surgeries and
optimal aesthetic results, particularly in complex correction of facial and skull
deformities. Their use, and that of CAD/CAM 3D models, has been shown to improve
the predictability of outcomes in complex cranio-maxillofacial surgery and to
decrease total operating time, thereby reducing the duration of intraoperative general
anesthesia and wound exposure time.1,2

Case Study

Ms. C, a 23-year-old woman, was

referred to Penn Plastic Surgery for correction of orbital hypertolerism, a condition
defined by excessive distance between the eyes and orbits, and vertical orbital
dystopia, a condition where the eyes are not level. Three-dimensional CT scans at
presentation revealed anterior and inferior displacement of the orbital bones and
bilateral nonalignment (Figure 1).
 Surgery to correct these defects
would require the orbits to be moved in three dimensions to differential degrees. Prior
to surgery, Ms. C received a cranial CT scan which was then converted into CAD
format. Three dimensional cephalometric measurements were then used to determine
the resection and placement/fixation parameters, and this was all “pre-planned” by the
surgical team. This data was then used to manufacture the respective templates for the
surgical procedure.

In the operating room, the bones of the orbits were able to be cut and repositioned
precisely based on CAD/CAM pre-fabricated jigs, an improvement in accuracy and
efficiency. She has recovered well, and returned to work four weeks after surgery.
Post-operative photographs and 3D-CT scans (Figure 2) have demonstrated a marked
improvement in her appearance, and she feels that her vision has been improved with
the surgery.

Reference
1. Mehra P, Miner J, D’Innocenzo R, Nadershah M. J Maxillofac Oral Surg.
2011;10:6–13.
2. Sharaf B, Levine JP, Hirsch DL, et al. J Craniofac Surg. 2010; 21:1277-1280.
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