Personalized titanium implant and maxillary sinus reconstruction in the management of midfacial fractures

Introduction

Fractures occurring in the midface represent approximately 27% of all facial fractures. These injuries primarily affect the younger population, with the highest frequency observed in the 15–24 years age group. Furthermore, there is a notable male predominance of 3 : 1 [1]. Craniofacial injuries encompass a range of severe morphological, functional, and aesthetic issues that can profoundly impact the functioning of various systems within the body, such as the respiratory, nervous, visual, and stomatognathic systems, and necessitates careful evaluation and a comprehensive treatment approach to achieve optimal outcomes.

Case report

We present a case report of a 22-year-old male patient who was admitted to the Department of Maxillofacial Surgery with facial deformities resulting from warfare-related injuries. Computed tomography (CT) examination revealed multiple fractures involving the right-sided maxilla, including the medial and anterior walls of the maxillary sinus and the orbital margin. Additionally, the CT scan showed various associated findings such as a wide junction between the right maxillary sinus and nasal cavity, thickening of the right maxillary sinus mucosa, mucosal swelling of the left inferior nasal auricle, thickened inferior oblique muscle of the right eyeball, and scarring lesions in the subcutaneous tissue of the orbital floor area. Moreover, a right nasolacrimal duct injury was confirmed. Ophthalmology consultation revealed limited retraction of the right eyeball, corneal scar, iris defect, limited visual field, and telecanthus on the right side. Neurological examination demonstrated V2 paraesthesia (figs. 1 A, B).
Based on multiple CT scans and 3D reconstruction findings, a personalized titanium implant was designed and subsequently fabricated using 3D printing technology. This innovative approach utilizes computer-aided design (CAD) digital models and standardized material to fabricate personalized three-dimensional objects [2]. Using three-dimensional printing technology played a crucial role in creating the personalized titanium implant, allowing for precise customization and improved surgical outcomes. By leveraging the capabilities of three-dimensional printing, the implant was tailored to fit the unique anatomical requirements of the patient [3]. The surgical intervention involved making an incision in the post-traumatic scar in the nasal root and the right suborbital region. A mini-plate located in the nasal root was visualized and removed. The personalized titanium implant was then affixed to the zygomatic bone, nasal root, and alveolar process to restore the orbital floor.
Craniofacial reconstruction procedures were performed to address the fractures of the orbital margin and tear ducts. The attachment of the right eye ligament and scar revision procedures were also carried out. Scar plasticity was performed using layered suturing techniques. The postoperative recovery period was uncomplicated, and the patient was discharged in good health (figs. 2 A, B).

Discussion

The evaluation of maxillary sinus fractures is typically conducted in collaboration with otolaryngologists and maxillofacial surgeons. The gold standard imaging in this type of trauma is a non-contrast computed tomography scan of the maxillofacial bones [4]. The literature reports various potential complications of maxillary sinus fractures, including maxillary sinusitis, maxillary sinus mucocele, oromaxillary fistula, dental malocclusion, and facial asymmetry, among others [5].
Therefore, close monitoring of patients in the outpatient setting is essential. This case report highlights the successful application of a personalized titanium implant and craniofacial reconstruction procedures to effectively manage multiple fractures involving the maxilla and orbital margin. Such fractures pose significant medical challenges due to their complexity, high prevalence, and socioeconomic implications [4]. The treatment of facial fractures necessitates a comprehensive, multidisciplinary approach. The integration of 3D printing technology in maxillofacial surgery has revolutionized patient care, particularly in cases where conventional surgical techniques are inadequate or yield suboptimal outcomes [6]. These advancements contribute to improving the overall quality of life for patients with complex midface fractures.

Funding

No external funding.

Ethical approval

Not applicable.

Conflict of interest

The authors declare no conflict of interest.

References