Patient Specific Implants to Solve Structural Facial Asymmetry After Orthognathic Surgery.

Facial asymmetry is a challenge for surgeons. Some surgical strategies could be used involved soft or hard tissue of the face. The aim of this report is to show the use of patient specific implants (PSI) in a puzzle strategy based on computer aided design/computer aided manufacturer to solve a complex structural facial asymmetry after orthognathic surgery. Twenty-five-year-old male patient complain for facial asymmetry after orthognathic surgery; main deformity was related to the shape of mandibular bone in the ramus, angle, and body. After mirror image, was chose an augmentation in the right side using 2-pieces patient specific implants and the bone reduction in the vertical high of the mandibular body in the left side. Surgical technique was realized by intra oral approach installing the ramus segment at first approach and the body segment as second to obtain stability in the fitting implant-bone-implant; the left side was treated using a guide for osteotomy; after 1-year follow-up no infection or complication was observed and facial symmetry was obtained. It is possible to conclude that the puzzle technique using polyetheretherketone can be applied to obtain predictable results in a simple strategy to solve a complex problem.