Stereolithography in Maxillofacial Surgery

Prof. C. Tyrnofyeyev, Prof. O. Gorobets; Kyiv Medical Academy of Postgraduate Education named after P.L. Shupik

Introduction
At the beginning of the 1970s Computerized Tomography evolved into medical practice. It was a
completely new diagnostic method allowing the visualization of the connections between the
isolated organs and tissues in normal or pathological conditions. CT took a strong position in the
diagnostics of the maxillofacial area.

In the last years, modern technology appeared for the creation of prototypes of the human
skeleton using the data obtained from CT and MRI. One of the most famous is stereolithography.
The basic principle of this method is the slice-by-slice building of the 3D model with exactly the
same size and shape of the human body parts.

Aim of analysis
To determine the diagnostic possibilities of stereolithography for diseases and traumas in the
maxillofacial area.

Materials and Methods

We first examined 47 patients. The standard clinical examination was done, which included X-
ray of the jaws in different projections and computerized tomography. Stereolithographic models
of the jaws were made by Materialise in Belgium.
Among the examined patients were patients with jaw tumors (ameloblastoma, osteoblastoma),
tumor-like (cysts) and inflammatory (maxillary sinusitis, osteomyelitis) processes, with jaw
deformations and defects, neurogenous diseases, patients with dental implants and with ankylosis
of TMJ.

The data obtained during the diagnostics by the stereolithography method was compared to the
results obtained during X-ray imaging, computerized tomography and with the post-op results.

Results of investigation
Stereolithography gives the possibility to obtain info about the real size and precise location of
the pathological focus in the jaw bone, the dimensions of the destruction area and its connections
with the surrounding bone structures (Fig. 1, 2).
 Building the colored stereolithography models permits us to see the tumor and its connections
with the blood vessels and nerves. We have precisely determined the exact place of the resection
of the jawbone affected by the ameloblastoma; it was also possible to choose the exact size of the
titanic implant on the jaw which should be used for the restoration of the bone defect.
With the stereolithography models we could determine precise size and location of tumors in the
hard accessible regions of the mandible (ramus), to see the connections with the alveolar nerve in
the mandible tunnel, to determine the presence or absence of the connections with the teeth, and
the grade of destruction of the bone walls, as well as their connections with such anatomic
formation as the mandible tunnel (Fig. 3a & b).
Stereolithographic models are also useful during differential diagnostics of malignant and non-
malignant tumors (Fig. 4).

In the inflammatory jawbones diseases, we’ve determined the level of correspondence of the
sequester’s size or polyposis, revealed during the surgery, to the size of the pathological focus on
the stereolithographic model and also could find the exact places of their location (Fig. 5),
In TMJ-ankylosis the stereolithographic method of investigation of the facial bones gave us the
possibility to determine the grade of fusion of mandible and surrounding bone structures, which
could help us to choose the correct size of the implants of TMJ, allow to reduce the risk of
unforeseen situations (damages of vessels and nerves, jawbones) during bone plastic surgery and
choose the correct surgery method in hyperformation and malformation of the jaws as well as the
correct obturators for the closing of the maxilla defects (Fig. 6a & b).

For patients with neuralgic diseases of the maxillofacial area caused by the narrowing of the
bone tunnel of II and Ill branches of the trigeminus, stereolithography permits us to determine
the precise location of this narrowing along the bone tunnel and to plan beforehand the access to
this region. During the dental implantation, the stereolithographic model permits us to determine
the location of the mandible nerve, the distance to the bottom of the maxilla sinus and nasal
cavity, as well as to see the centers of regional osteoporosis.

Conclusion
Stereolithography is one of the modern investigational methods that obtains the 3-dimensional
model of the facial skeleton bones. This method gives the possibility to clearly determine the
exact location of the pathological focus and its real size, as well as to choose and plan the
method of the surgery, reducing the risk of post-op complications.
Stereolithography is recommended for general use in maxillofacial surgery.