Patient-specific reconstruction utilizing computer assisted 3D modelling for partial bone flap defect in hybrid cranioplasty
| dc.contributor.author | Hueh, Low Peh | |
| dc.date.accessioned | 2019-08-15T01:51:28Z | |
| dc.date.available | 2019-08-15T01:51:28Z | |
| dc.date.issued | 2017 | |
| dc.description.abstract | Background: Autologous cranioplasty using a patient’s original bone flap remain the commonest practice nowadays. However, partial bone flap defect is commonly encountered. Replacing the bone flap with pre-moulded synthetic bone flap is costly and might not be affordable for all patients. Hence, some small to medium size defects were topped up with alloplastic material on a free hand basis intra-operatively that often resulted in inaccurate implant approximation with unsatisfactory cosmetic result. This rationale the need for an alternative technique for reconstruction of partial bone flap defect in cranioplasty. The objective of this study is to evaluate implant accuracy and cosmetic outcome of cranioplasty candidates with partial bone flap defect who underwent reconstruction utilising computer assisted 3D modelling. Methods: This study consisted of thirteen patients. 3D images of their skull were obtained from post-craniectomy axial 1-mm spiral computed tomography (CT) scans and virtual 3D models were generated using Materialise Mimics software. The Materialise 3-Matic was utilised to design patient-specific implant. Prefabrication of the implant performed by a 3D Objet printer, and negative gypsum molds were created with the prefabricated cranial implant. Intra-operatively, hybrid polymethyl methacrylate (PMMA)-autologous cranial implants were produced using the gypsum molds, and fit into the cranial defect. Results: Thirteen patients underwent partial bone flap reconstruction utilising this technique. One patient involved in motor vehicle accident prior to outcome !assessment; another patient experienced implant exposure and underwent implant removal. The rest of the patients revealed satisfactory implant alignment with favourable cosmesis. The mean visual analogue scale for cosmesis (VASC) was 91, mean implant size was 50cm2, and the mean duration of intra-operative reconstruction for the partial bone flap defect was 30 minutes. All of them revealed excellent implant alignment and improvement in quality of life following surgery as measured by the SF-36 score. Cost analysis revealed that this technique is more cost-effective compared to customized cranial prostheses. The cost of a customized cranial prosthesis range from RM10,000 to RM15,000 depending on the size of cranial defect. Whereas the production cost for an individualized hybrid PMMA-autologous bone implant using this technique range from RM 3,000 to RM 4,000. Conclusion: This new technique and approach produces hybrid autologousalloplastic bone flap that resulted in satisfactory implant alignment and favourable cosmetic outcome with relatively low costs. | en_US |
| dc.identifier.uri | http://hdl.handle.net/123456789/8619 | |
| dc.language.iso | en | en_US |
| dc.publisher | Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia | en_US |
| dc.subject | Skull | en_US |
| dc.subject | Abnormalities | en_US |
| dc.title | Patient-specific reconstruction utilizing computer assisted 3D modelling for partial bone flap defect in hybrid cranioplasty | en_US |
| dc.type | Thesis | en_US |
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