Facial reconstruction after pre maxillary resection in a bilateral cleft lip and palate patient - a case report Technologies for resection and reconstruction of mandibular lesions.

Loss of the premaxilla is a rare event while treating patients with bilateral cleft lip and palate. Its resection is no longer an acceptable method of treatment in modern practice. Nowadays, most cases of premaxillary loss are secondary to treatment and manipulation of the premaxilla, and not due to intentional resection. In the following case presentation we present the treatment of a seven years old boy, presented to our institution after being treated for bilateral cleft lip and palate by resection of the premaxilla. Through a series of operations including bone grafting, distraction of the maxilla, and cartilaginous graft we managed to reconstruct a proper facial habitus, a convex facial profile and nasal projection. Restoring the bony structure of the face is a significant challenge. Due to the complex three dimensional anatomy, the presence of critical structures and the variety and uniqueness of each deficiency it is essential to form the optimal surgical plan and to execute it precisely. Development of computer aided manufacturing (CAD/ CAM - computer assisted design / computer assisted manufacturing) and advances in manufacturing technologies and material science brought a whole array of options and tools for the purpose of planning and performing computer assisted surgery. CAD/CAM technology allow for various application: Manufacturing of a physical anatomical model, Using the 3D model for hardware pre-bending, Manufacturing of cutting jigs and intraoperative fixation templates, Manufacturing of custom made implants. The surgeon may choose which of the application to use in any specific case or combine all of these abilities according to the complexity of the case. Two cases presenting the applications of these technologies will be reviewed.