The Use of Virtual Surgical Planning and 3D Printed Patient Specific Guides to Optimize Esthetic Outcomes of Hydroxyapatite Cement Onlay Cranioplasty

Craniofacial procedures such as fronto-orbital remodelling can result in forehead contour irregularities and bitemporal hollowing many years following the initial surgery. Hydroxyapatite cement (HAC) cranioplasty is a secondary surgical procedure that can be used to recontour the forehead and superior orbital rim. This approach relies on the surgeon's subjective assessment of form and aesthetics both preoperatively and intraoperatively. The highly artistic nature of this procedure means that outcomes, although often good, can be inconsistent and may result in undercorrection or overcorrection. The following case report describes a 14-year-old female who underwent HAC onlay cranioplasty to correct forehead asymmetry, irregular contours and supraorbital retrusion following bifronto-orbital advancement surgery for unicoronal synostosis. This is the first case described where virtual surgical planning (VSP) with 3D printed patient-specific guides was used to reduce the highly subjective nature of onlay cranioplasty and increase precision, efficacy, consistency of results and aesthetic outcome.