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
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.
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.
Penn Medicine’s Adult Craniofacial Reconstructive Surgery Program is focused on the care of patients seeking consultation about their facial function and appearance. Penn surgeons use the latest technology for both cosmetic and reconstructive surgery, including CAD-CAM technology for cranial, facial and jaw surgery and microsurgical innovations to visualize and re-attach severed blood vessels and nerves, and optimize post-surgical feeling and function. In addition, the Center uses lasers, dermabrasion and chemical peels to treat skin conditions, and collaborates with skin care specialists to ensure that patients’ skin care needs are met.
Jesse A. Taylor, MD
Assistant Professor of Surgery
Scott P. Bartlett, MD
Professor of Surgery
Oral and Maxillofacial Surgery
Eric J. Granquist, DMD, MD
Joli C. Chou, DMD, MD
Otorhinolaryngology-Head and Neck Surgery
Ara A. Chalian, MD
Associate Professor of Otorhinolaryngology:
Head and Neck Surgery
M. Sean Grady, MD
Charles Harrison Frazier Professor of Neurosurgery
James M. Schuster, MD, PhD
Associate Professor of Neurosurgery
Center for Human Appearance
Perelman Center for Advanced Medicine
East Pavilion, 1st Floor
3400 Civic Center Boulevard
Philadelphia, PA 19104
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