In 1997, Orthopaedic Innovation introduced Engineering Assisted Surgery (EAS) techniques into a complex surgical procedure to correct an unsuccessful craniofacial surgery procedure that had been carried out on a patient. Remarkably, following successful corrective surgery using EAS, the patient regained the vision in his left eye, which had previously been lost. This restoration in sight, which gave the patient back full 6/6 vision, remains an unexplained yet highly welcomed outcome of this operation.

Case history

Following a serious road traffic accident in 199?, initial treatment had left patient Daven Spriggs with serious malunion of a fractured cheek bone (malar), which had also been incorrectly positioned. Daven’s nasal bones deviated to the right side and a silastic implant, used to reconstruct the orbit, was visibly extruding through his skin.

At the time of initial surgery, biomodel planning was not an established technique; however, it was considered that accurate treatment planning together with EAS would offer the Daven the optimal outcome.

Working with the surgeon, Orthopaedic Innovation developed a custom-made jig to section and reposition the malar and nasal bones in the correct anatomical position (Figure 3). In doing so, the surgeon achieved the planned position of attaining normal contour of the orbit together with a malar that had been lifted upwards and inwards.

Stereoscopic Lithography

During surgery, which was carried out in July 1998, bone grafts were not required as the stereoscopic model - with attached preformed bone plates and orbit prosthesis, developed by Orthopaedic Innovation (figure 5), was sterilised as a single unit.

The surgeon managed to achieve a facial symmetry of within 0.5mm of the unaffected side, as measured on post operative x-rays, and the re-fractured cheek bone was correctly positioned using the customized craniofacial jig that had been temporarily screwed onto the forehead during the operation. The orbit was reconstructed with a customised CNC engineered implant and eyelid paralysis was successfully treated with a gold weight implant that was inserted under the skin.

Engineering Assisted Surgery intervention

This case shows how the introduction of Engineering Assisted Surgery, not only dramatically improved this particular patient’s quality of life, but also helped healthcare professionals in the following ways:
• Enhanced diagnosis
• Enhanced accuracy in planning
• Increased margins of safety in major surgery
• Surgical prediction
• Facilitated an easier transfer of the plan to the patient
• Reduced in surgical trauma
• Enhanced the outcome
• Facilitation of an audit
• Assisted medicolegal assessment of personal injury

Case Summary

In this case, neither a second donor surgical site to effect the primary reconstruction, or operative intensive care was required following surgery, which lasted eight hours in the operating theatre. The fact that bone grafting was not required further enhanced rehabilitation of the patient and, in the future, could lead to significant cost savings for purchasers of health care.

Eight years following this corrective craniofacial surgical procedure, the patient still has very good aesthetics related to skeletal contour as well as 6/6 vision, which, incidentally remains to be an extraordinary and unexplained result of this very successful operation.