Trabecular Titanium Customised Cranioplasty Case Analysis The patient´s skull´s 3D reconstruction shows a front-sphenoid-temporo-parietal defect in the right hemisphere, due to previous tumoural resection. Design Process The patient has unsuccessfully had several implants placed previously, made of different biomaterials for cranio-plastic reconstruction. As a solution proposal, a titanium customised plaque was designed. It had two parts: a solid edge that is in contact with soft tissues and a trabecular that is osseointegrated, makes the structure lighter and has thermal properties similar to the surrounding tissue. Trabecular titanium assures the best interphase between the bone and the implant. With this technology, it is possible to obtain titanium components with perfectly-controlled porosity. The 3D structure with hexagonal cells copies the bone morphology, and it creates an ideal environment for cell colonisation and for the new bone tissue revascularization. Surgical Intervention 3D Biomodel and Implant To assure the accurate performance of the surgical plan and implant fitting, a patient´s skull´s biomodel was printed using 3D technology. The new manufacturing technologies for patient-specific implants, which enhance transdisciplinary work between surgeons and our engineers, allow for innovative therapeutic alternatives for complex cases. www.raomed.com.ar Av. Circunvalación 3085 Córdoba Phone number: +54 351 4650282 Postcode 5010 Córdoba - Argentina Tumour Resection from the Right Superior Orbital Frontal Area. Functional and Aesthetic Repair with Customised Implant Placed in the Same Surgical Procedure. Case Analysis 3D image processing allows surgeons to distinguish the typical morphology of the fibrous dysplasia in the right superior orbital area of the healthy tissue. With this virtual tool, the surgeon sets the safety margins and plans the area to be resected with precision. Design Process Through virtual models, the surgeon was able to set the resection margins with high precision. In accordance with this planning, a resection guide and the customised implant that will repair the affected area with high precision were designed. 3D Biomodels To assure the precise performance of the surgical plan, biomodels were printed using 3D technology, and a surgical guide was manufactured to cut the affected area, in accordance with the surgeon´s exact indication. Intrasurgical Navigation Using the surgical guide placed by intrasurgical navigation allowed for resecting in accordance with the pre-planned precision, and for placing the customised implant that was manufactured based on this planning. After this, perfect anatomical coincidence was achieved. Surgical Intervention Thanks to joint work between physicians and our engineers, it was possible to perform in only one intervention a procedure that would have implied two surgeries if it had been performed in a conventional way. Besides, risk chances and costs were reduced, and the patient´s intended aesthetic result was optimised at the same time. www.raomed.com.ar Av. Circunvalación 3085 Córdoba Phone number: +54 351 4650282 Postcode 5010 Córdoba - Argentina Fibrous Dysplasia Extended to Frontal, Sphenoid and both Parietal Bones. Assisted Planning of Resection, Design and Manufacturing of Customised Surgical Guides and Implants for Bone Reconstruction. Case Analysis A big-sized fibrous dysplasia resection was planned. To do it, digital tools were used to analyse bone thickness and density in every section to be intervened. Afterwards, surgical guides were manufactured to orient the cutting of the bone to be resected, for whose positioning an intrasurgical navigator was used. Besides, the necessary customised implants that would allow the correct closure as well as anatomical and functional repair were designed and manufactured. Design Process The margins of healthy tissue as well as resection setting are highlighted in the model in accordance with the surgeon´s indication, and they are validated through a bone thickness analysis carried out with specialised software. Cutting guides were designed based on the virtual and physical models, respecting the surgeon´s planning accurately. From this detailed planning, customised implants were designed in two separate pieces, given the complexity and size of the defect to be repaired. Supra eyebrow ridge orbit and area repair was achieved with optimal aesthetic results and perfect anatomical coincidence. The material chosen by the surgeon was PMMA (Polymethylmethacrylate), widely used and effectively proved for conventional craneoplasties. 3D Biomodels The surgery was rehearsed using 3D-printed biomodels, which reproduce the patient´s anatomy and the designed pieces accurately. Through computer-assisted design and manufacturing techniques, added to virtual pre-surgical planning and intrasurgical navigation, it was possible to resect the dysplastic area and to place the repair prostheses in only one surgery. www.raomed.com.ar Av. Circunvalación 3085 Córdoba Phone number: +54 351 4650282 Postcode 5010 Córdoba - Argentina
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