3D printing aids in midface surgery

By Jonathan Skirko, MD, craniofacial plastic surgery and pediatric otolaryngology
Children with a cleft lip and palate often have difficulty with a sunken in face (midface) around the nose (maxillary hypoplasia). This usually results in a hollow appearance of their face but also causes dental and chewing problems because the teeth don't line up properly. Patients with this problem will eventually need a surgery where the bones in the central face and upper jaw are moved forward – called a LeFort 1 osteotomy (cutting the bone of the midface) and maxillary advancement (bringing the midface forward).

The upper jaw with the upper teeth is released and moved into alignment with the lower jaw. Occasionally the lower jaw position needs to be adjusted with a lower jaw surgery. The bone is stabilized with metal plates and screws holding it in the new position. My preference is to precisely plan jaw surgery through virtual surgical planning. Using 3D printed cutting guides and plates that hold the jaws in position, this innovative and customized method makes the procedure more precise.
Most children have this procedure when they are fully grown, but if a child has a severe sunken in midface or airway problems, they may require this procedure around the age of 9. When done early in childhood or when larger distances are used, it is often done by slowly moving the upper jaw bone using distraction osteogenesis. For this procedure, the upper jaw is cut and slowly advanced to its final position. The force of slowly moving the upper jaw forward stimulates bone growth. After the upper jaw is in the desired position, the bone continues to harden over several weeks. To help get the best result, a child's orthodontist will get the teeth ready for the jaw movement. Once the teeth are moved into their new position, the jaw surgery will allow the teeth of the upper and lower jaw to line up (or occlude) normally. After the surgery, some subtle movements are often needed.

For more information or to refer your patient, please call 520-874-4700.
 
Before jaw surgery
After jaw surgery