case_images: PMC3420424_01
case_images: (a) Shows on the left an obvious skull deformity after crush injury. Bone is largely missing and the left orbital margin is severely compromised. The right eye is removed. (b) A composite 3D reconstruction of the patient's skull showing the extensive bone loss and sequelae of multiple skull and facial fractures.
case_images: CRIM.OTOLARYNGOLOGY2011-749250.001.jpg
case_images: PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.001.jpg
case_images: fig1
case_images: A 48-year-old German safety officer suffered compression injury to his cranial vault whilst examining a pressing machine (Figure 1(a)). This led to compound comminuted skull and facial fractures (parietal, sphenoid, frontal, orbital rim, ethmoid, maxillary, zygomatic, and nasal bones) (Figure 1(b)).
case_images: This figure shows a computerized reconstruction of the bony defect. This is used as a template for construction of a titanium cranioplasty prosthesis.
case_images: CRIM.OTOLARYNGOLOGY2011-749250.002.jpg
case_images: PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.002.jpg
case_images: fig2
case_images: A computer-assisted designed/computer-assisted modeled (CAD/CAM) titanium implant for cranioplasty was manufactured using the DICOM high-resolution CT dataset (Figure 2).
case_images: Prereconstruction photograph. Due to the expected skin loss, two inflatable skin expanders had been inserted.
case_images: CRIM.OTOLARYNGOLOGY2011-749250.003.jpg
case_images: PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.003.jpg
case_images: fig3
case_images: The titanium cranioplasty prosthesis installed and fixed with self-drilling 7 mm screws (Figure 3).
case_images: (a) Shows the "in situ" titanium cranioplasty. Note the fit and screw fixation to the defect margins. (b) Postoperative view after tension-free skin closure.
case_images: CRIM.OTOLARYNGOLOGY2011-749250.004.jpg
case_images: PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.004.jpg
case_images: fig4
case_images: The previous tissue expansion resulted in tension-free skin closure over the implant (Figure 4(a)). Excess skin was left in expectation of flattening as healing occurred (Figure 4(b)).
case_images: Showing the patient one week after surgery. The missing bone has been replaced by the titanium cranioplasty prosthesis. Wound healing was excellent and the excess skin flattened. A prosthesis will be fitted to replace his right eye.
case_images: CRIM.OTOLARYNGOLOGY2011-749250.005.jpg
case_images: PMC3420424_01_CRIM.OTOLARYNGOLOGY2011-749250.005.jpg
case_images: fig5
case_images: This was found to be the case at 1 week after surgery (Figure 5).