BACKGROUND: Odontogenic fibromyxoma (OFM) is a round and locally invasive neoplasm predominantly seen in the mandible. Though radiographic appearance is variable, definitive diagnosis is based on correlation with histopathological examination. Surgical approach is the treatment of choice. For reconstruction, patient-specific implant (PSI) has lately been developed as a crucial help.
METHODS: This case report presents a 19 year old female patient with odontogenic fibromyxoma highlighting its clinical, radiographic, histopathological features along with rehabilitation using patient specific implants reducing the complexity and related morbidities of reconstructive procedures.
CONCLUSIONS: Surgical repair and reconstruction of defects in cranio-maxillofacial region is challenging. The described treatment eliminates the need for bone grafting, shows optimal results owing to the shorter rehabilitation time and more accurate fits.
CONCLUSIONS: This report introduces a novel technique whereby patient-specific implants are employed as the primary method of reconstruction following segmental resection.

An 11-year-old girl presented at the emergency service with a nasal defect caused by a dog bite in the midface. Autologous nose reconstruction in the pediatric population is challenging due to donor site morbidity and remaining facial growth. Temporary prosthetic treatment is difficult to accept due to problems with retention. We present an innovative solution using a 3D printed patient specific titanium implant for support of a nasal prosthesis. With preoperative 3-dimensional planning, the implant can be designed to find fixation in the areas with the best bone quality, avoid potential damage to tooth buds and dental roots and avoid interference to soft tissues such as the nasal septum. Clear communication between the anaplastologist, surgeon and medical engineer is crucial for treatment success. The impact of facial growth is still unclear and will have to be assessed.

UNASSIGNED: To suggest a directing algorithm for rehabilitative management of complex soft and hard tissue defects due to mucormycosis.
UNASSIGNED: An utmost need for surgical, reconstructive and rehabilitative options; functional, aesthetic, acceptable to the patient and enduring rehabilitation.
UNASSIGNED: Different cases of rhinomaxillary mucormycosis pertaining to the facial skeleton, diagnosed with the help of radiographic as well as fungal cultures.
UNASSIGNED: Thorough medical assessment, and antifungal prescription; followed by surgical resection of the affected areas, rigorous follow-up scheme and later rehabilitation with the help of implants and immediate loading.
UNASSIGNED: Regular follow-ups for at least one year and successful rehabilitation providing acceptable functional outcomes.
UNASSIGNED: Unconventional pathologies like rhinomaxillary mucormycosis infecting the jaws require novel, unprecedented and elaborate procedures both surgical and reconstructive based on sound scientific principles. There must be a vision for the rehabilitation of such cases right from the commencement of the surgical treatment.

Silent sinus syndrome is a rare disorder characterized by ipsilateral enophthalmos and hypoglobus following a collapse of the orbital floor, in the presence of asymptomatic long-term maxillary sinusitis. It results in enophthalmos, hypoglobus and deepening of the superior palpebral sulcus. A standardized treatment protocol for this infrequent syndrome has not yet been established. The management includes restoration of maxillary sinus ventilation with functional endoscopic sinus surgery and orbital reconstruction, either concurrently or separately. In this paper, the authors presented two patients successfully treated with patient-specific implants, and intraoperative navigation. These cases highlight the benefit of computer-assisted planning and titanium patient-specific implants in the management of silent sinus syndrome. To the best of our knowledge, this is the first report that described the use of PSI with titanium spacers performed with the aid of intraoperative navigation for SSS treatment. Advantages, drawbacks of this technique and treatment alternatives currently available in the literature were also discussed.

This report describes the surgical reconstruction of large maxillofacial defect caused by a short-range gunshot injury in a dog using titanium patient-specific implant (PSI). A 3-year-old male Wolf Shepherd was admitted for a large right facial defect with right nasal cavity exposure caused by a gunshot injury. Radiographic examination revealed severe loss of the right maxillary, nasal, and incisive bones, multiple fractures of both left and right palatine bones, and a comminuted fracture of the right mandible. Initial surgical procedure included computed tomography (CT) imaging for three-dimensional (3D) implant design. Open wound management was maintained for 18 days until the fresh granulation tissue fully covered the wound bed. The implant was designed in a \"hand grasping shape\" to cover the defect, align multiple fractured palatine bones, and make a snap fit function. Multiple holes, including cortical screw holes, were added to the final design. The implant was printed on a titanium alloy. Surgical application of titanium PSI was performed 19 days after the primary surgery. A free sublingual mucosal graft was used to reconstruct the mucosal layer of the right nasal cavity. The mucosa was then covered with collagen membrane to strengthen the structure of the nasal cavity. Blunt dissection of the hard palate mucoperiosteum above the palatine process and palatine bones, soft tissue above the maxilla was performed, and the 3D printed titanium implant was fastened in a preplanned position. The facial soft tissue defect was reconstructed, and the titanium PSI was covered using an angularis oris cutaneous flap. Partial flap necrosis occurred in the rostral aspect, and the wound was managed to heal by a second intension. Flap dehiscence at the junction of the flap and hard palate mucoperiosteum occurred with exposure of the implant 2 days postoperatively. Multiple attempts to close the defect failed, and the owner wanted to stop treatment. Healthy granulated tissue was observed proximal to the implant. The defect no longer increased in size and did not show any noticeable complications related to the defect at 60 days after titanium PSI application, and the dog was discharged. Six months post-operatively, the dog remained active with great appetite, gained weight, and showed acceptable facial symmetry without enlargement of the implant exposure or any implant-related problems.

To develop a novel 3D-printer-assisted method to fabricate patient-specific implants for cranioplasty and to demonstrate its feasibility and its use in 16 consecutive cases.
We report on 16 consecutive patients who have undergone cranioplasty surgery for an extensive skull defect after decompressive surgery and in which the bone flap was not available. We present the workflow for the implant production using a 3D-printer-assisted molding technique. Preoperative, intraoperative, and postoperative data were analyzed/evaluated.
Eleven out of our 16 patients (68.7%) presented with extensive hemispheric bone defects. Indication for initial craniotomy were traumatic brain injury (4; 25%), acute subdural hematoma (4; 25%), ischemic stroke (3; 18.8%), tumor (3; 18.8%), and ruptured aneurysm (2; 12.5%). Median (range) operation time was 121 (89-206) minutes. Median (range) intraoperative blood loss was 300 (100-3300) mL. The mean (range) follow-up period is 6 (0-21) months. Complications occurred in 7 out of our 16 patients (43.8%), in 6 (37.5%) of which a reoperation was required to evacuate an extra-axial hematoma (3; 50%), for shunting of an epidural fluid collection (1; 16.7%), or for skin flap necrosis (1; 16.7%). One patient (16.7%) developed a chronic asymptomatic subdural fluid collection that was stable over the follow-up period.
Our workflow to intraoperatively produce patient-specific implants in a timely manner to cover cranial defects proved to be feasible. The results are cosmetically appealing, and postoperative CT scans show well-fitting implants. As implantable printable substrates are already available, we aim to advance and certify 3D-printed patient-specific implants in the near future.

Arhinia (congenital absence of the nose) is a congenital rare disease, which has been reported in less than 60 cases in the literature. It consists of the absence of external nose, nasal cavities and olfactory apparatus and is generally associated with midline defects, microphthalmia, blepharophimosis and hypotelorism. Aesthetic problems as well as associated functional anomalies can potentially impact on the development and interpersonal relationships of the child at a later stage in life. Arhinia requires extensive management in early life in order to ensure airway patency and protection by means of tracheostomy, and to allow adequate pharyngeal and feeding function to the child. Aesthetic issues are managed with reconstructive surgery or an external prosthesis. There is no previous description in Literature of internal prosthetic devices used to sequentially shape soft tissues in complex reconstruction. We present an example of design and manufacturing of a bespoke nose implant produced by means of 3D printing and directly assessed on-table by means of 3D surface scanning.