PMC3420424_01
(a) Shows on the left an obvious skull deformity after crush injury. Bone is largely missing and the left orbital margin is severely compromised. The right eye is removed. (b) A composite 3D reconstruction of the patient's skull showing the extensive bone loss and sequelae of multiple skull and facial fractures.
CRIM.OTOLARYNGOLOGY2011-749250.001.jpg
PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.001.jpg
fig1
A 48-year-old German safety officer suffered compression injury to his cranial vault whilst examining a pressing machine (Figure 1(a)). This led to compound comminuted skull and facial fractures (parietal, sphenoid, frontal, orbital rim, ethmoid, maxillary, zygomatic, and nasal bones) (Figure 1(b)).
This figure shows a computerized reconstruction of the bony defect. This is used as a template for construction of a titanium cranioplasty prosthesis.
CRIM.OTOLARYNGOLOGY2011-749250.002.jpg
PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.002.jpg
fig2
A computer-assisted designed/computer-assisted modeled (CAD/CAM) titanium implant for cranioplasty was manufactured using the DICOM high-resolution CT dataset (Figure 2).
Prereconstruction photograph. Due to the expected skin loss, two inflatable skin expanders had been inserted.
CRIM.OTOLARYNGOLOGY2011-749250.003.jpg
PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.003.jpg
fig3
The titanium cranioplasty prosthesis installed and fixed with self-drilling 7 mm screws (Figure 3).
(a) Shows the "in situ" titanium cranioplasty. Note the fit and screw fixation to the defect margins. (b) Postoperative view after tension-free skin closure.
CRIM.OTOLARYNGOLOGY2011-749250.004.jpg
PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.004.jpg
fig4
The previous tissue expansion resulted in tension-free skin closure over the implant (Figure 4(a)). Excess skin was left in expectation of flattening as healing occurred (Figure 4(b)).
Showing the patient one week after surgery. The missing bone has been replaced by the titanium cranioplasty prosthesis. Wound healing was excellent and the excess skin flattened. A prosthesis will be fitted to replace his right eye.
CRIM.OTOLARYNGOLOGY2011-749250.005.jpg
PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.005.jpg
fig5
This was found to be the case at 1 week after surgery (Figure 5).