Gridplan Midfacial Analysis for Alloplastic Implants at the Time of Jaw Surgery

BACKGROUND: Middle-third facial implants are primarily indicated for facial plastic surgery and orthognathic surgery as well as the secondary treatment of facial trauma and congenital malformations. Several methods of clinical analysis have been described both for defect classification and for surgical technique and implant materials. These prove very difficult to apply so as to establish a precise standard. METHODS: A new frontal-view facial analysis was developed on the basis of a grid of three vertical and five horizontal lines, divided in turn into six high and four lower middle-third areas with three vertical lines on side view. These vertical lines (LC and P) prove useful for the purposes of quantifying degree of defect. The lines can be marked on the patient's face during the intraoperative phase so as to ensure correct implant placement. Medpor implants were applied and secured by means of circumvestibular incision during Le Fort I osteotomy with titanium miniscrews. RESULTS: One hundred fifty-one patients with zygomatic defects were treated by means of this method during the correction of facial malocclusion. The results were achieved as planned during the preoperative phase in all cases. Postoperative complications were of minor severity, and only one implant was removed. CONCLUSIONS: This method of facial analysis is simple, and the drawing of lines proves useful to ensure correct implant positioning and symmetry during the surgical phase. In addition to being very easy to apply, position, and shape, Medpor implants also offer long-term stability and involve no any major complications.