3D Volume Assessment Techniques and Computer-Aided Design and Manufacturing for Preoperative Fabrication of Implants in Head and Neck Reconstruction Ashish Patel, DDS, MD a , David Otterburn, MD b , Pierre Saadeh, MD b , Jamie Levine, MD b , David L. Hirsch, DDS, MD c, * Three dimensional (3D) facial analysis and virtual surgical simulation has revolutionized the way surgeons diagnose, treat, and reconstruct head and neck diseases and defects. In our modern computer era, digital planning has been the stan- dard in architectural design, engineering, and bio- medical fabrication; this trend has recently made an impact on clinical medicine and surgery. In all aspects of surgery, proper planning facilitates more predictable operations and operative results, but prior to the use of virtual planning, much of this relied on inaccurate surgical models, intraoper- ative trial and error, and 2-dimensional (2D) imaging. This process increases operative time, operator frustration, and postoperative inaccuracies. The goal of this article is to illustrate the ease with which virtual surgery and computer-assisted design can be integrated into one’s armamentarium, and benefit the surgeon and the patient with more precise surgical planning, decreased operating time, and creation of accurate postoperative results compared with traditional craniomaxillofacial sur- gical treatment planning. At their institution, the authors have reliably achieved excellent results in corrective surgery of the jaws, maxillofacial trauma, temporomandibular joint reconstruction, skull base surgery, jaw reconstruction, head and neck oncologic surgery, and postablative recon- struction. For the 901 cases the authors have virtu- ally planned and completed, the cost has ranged from 2000 to 4000 dollars per case depending on the amount of templates and implants fabricated. These techniques have become the authors’ preferred method for complex craniomaxillofacial surgery and reconstruction. CORRECTIVE JAW SURGERY Orthognathic surgery is widely used in the correc- tion of craniomaxillofacial deformities. There is The authors have nothing to disclose. a Division of Oral and Maxillofacial Surgery, New York University Langone Medical Center, 462 First Avenue, Suite 5 South, New York, NY 10016, USA b Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, 560 First Avenue, Suite TH169, New York, NY 10016, USA c Division of Oral and Maxillofacial Surgery, Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, 560 First Avenue, Suite TH169, New York, NY 10016, USA * Corresponding author. Manhattan Maxillofacial Surgery, 366 Fifth Avenue, Suite 709, New York, NY 10001. E-mail address: davidlhirsch@yahoo.com KEYWORDS  Three dimensional volumetric analysis  Craniomaxillofacial surgery  Computer-aided design  Head and neck reconstruction  Virtual surgical planning Facial Plast Surg Clin N Am 19 (2011) 683–709 doi:10.1016/j.fsc.2011.07.010 1064-7406/11/$ – see front matter Ó 2011 Published by Elsevier Inc. facialplastic.theclinics.com