ThreE-dimensional CT reconstruction in midfacial surgery

Correct preoperative planning is an essential aspect of any surgical procedure and it is equally important when midfacial reconstruction is contemplated. Conventional methods include standard radiographic views, plain tomography, photography, and computerized tomography. All of these methods produce a two-dimensional image of the patient. Three-dimensional computerized tomographic reconstruction allows the surgeon to visualize the entire facial skeletal deformity. The three-dimensional image produced also allows comparison of the deformity to surrounding normal structures, and thus makes the correction of facial asymmetries more precise. This new modality is particularly useful in the preoperative planning for patients with zygomaticomaxillary defects that result from either trauma or maxillectomy. Illustrative examples of patients in whom autogenous bone graft zygomaticomaxillary reconstruction was performed, after trauma and subsequent to subtotal maxillectomy, are presented. The amount and exact placement of the grafts was determined preoperatively from the analysis of the three-dimensional CT reconstruction, and the surgical planning was thereby simplified.