The Use of Three-dimensional Evaluation in the Management of a Complex Patient With Mandibular Fracture

Abstract

The aims of this study were to diagnose and evaluate a case of severe condylar fracture followed up over 5 years using three-dimensional imaging for soft tissue and hard tissue. The patient underwent reconstruction with an autogenous rib graft to correct the resorbed left condyle secondary to a previous fracture and to balance her facial asymmetry. Orthodontic treatment is ongoing to equilibrize the occlusion and dentofacial complex. A stereo-photogrammetric system (3dMDFace System) was used to capture the soft tissue image of the patient. In addition, a cone-beam computed tomography (Kodak 9500) was used for hard tissue acquisition. The resultant images were analyzed using Rapidform 6 (RP6) and 3dMDvultus three-dimensional software packages, for 3 time frames: before surgery (T1), 1 month after surgery (T2), and 8 months after surgery (T3). Using three-dimensional software to analyze the three-dimensional data, several findings were noted: (1) soft tissue compensation of the hard tissue deformity for the facial asymmetry was around 7 mm; (2) color mapping and histograms helped identify distinct facial differences represented by positive changes of the patient's face because of the mandible reconstruction at T1-T2 and the mandible moving to its normal position at T3-T4. Three-dimensional imaging provides more accurate information and virtual representation of the patient. This leads to better diagnosis and treatment planning. In addition, the preliminary results of this study showed supportive evidence for the use of rib grafts in children.