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Facial Skeletal Augmentation with Custom Implants Using Computer-Assisted Design (CAD) and Computer-Assisted Manufacturing (CAM) Technology
Alan Yan, MD1, Michael J. Yaremchuk, MD2.
1Massachusetts General Hospital, Boston, MA, USA, 2Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA.

Purpose:
The purpose of the study is to describe the evaluation, technique, and to assess the outcomes, of custom-made facial implants using computer-assisted design (CAD) and computer-assisted manufacturing (CAM) technology in restoring or improving contour of the facial skeleton.
Methods:
A retrospective review of the senior author’s experience with the modality was conducted.
Results:
From 2011-2014, 90 patients underwent CAD-CAM facial skeletal augmentation. Surgical indications included aesthetic skeletal enhancement (40%), post-orthognathic surgical irregularities (25%), facial rejuvenation (20%), and congenital/post-traumatic facial asymmetry (15%). Pre-operative medical CAT scan (CT) or office-based cone beam CT (CBCT) was obtained for each patient to reconstruct a virtual three-dimensional model of the facial skeleton. This allows for millimeter assessment of the contour deficit: symmetry, height, width, projection, and its relationship to the entire facial skeleton. Knowledge of the normal skeletal relationship and aesthetic criteria are integral in implant design to provide the optimal surgical result (Figure 1 & 2).
Conclusions:
Facial skeletal augmentation with custom implants using CAD-CAM technology allows precise pre-operative analysis and surgical planning. Custom implants provide better fit and more predictable post-operative facial contour than stock implants. Disadvantages include higher surgical cost from pre-operative CT and custom implant manufacturing.


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