Abstract:
Disclosed herein are patient-specific craniofacial implants structured for filling bone voids in the cranium as well as for simultaneously providing soft tissue reconstruction and/or augmentation for improved aesthetic symmetry and appearance. Pterional voids or defects generally result from a chromic skull deformity along with a compromised temporalis muscle or soft tissue distortion from previous surgery. When muscle atrophy occurs in the pterion, temporal hollowing generally results where there would be soft tissue but for the atrophy. The patient-specific temporal implants herein are configured to have an augmented region adjacent the temporal region of the cranium in order to account for and correct any such temporal hollowing.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    The present application is a divisional of the U.S. patent application Ser. No. 13/963,225, filed on Aug. 9, 2013, the disclosure of which is incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to patient-specific craniofacial implants and methods of designing such implants for filling both bone and soft tissue in the temporal region of a patient&#39;s head. 
       BACKGROUND OF THE INVENTION 
       [0003]    Certain congenital conditions and acquired deformities related to surgery, irradiation, and/or trauma may result in varying sized and shaped voids in bone and soft tissue. For example, severe impacts to the head could leave the frontal, parietal and/or temporal areas of the craniofacial skeleton in need of repair. Cranial bone voids are commonly filled throughout the anterior, middle, and posterior cranial vaults, for example, using autologous bone flaps, standard or customized alloplastic implants, titanium mesh, biologic absorbable materials, tissue engineered substrates and/or liquid methyl methacrylate in order to provide much needed cerebral protection. However, in times where secondary cranioplasty requires a bone substitute, temporal hollowing needs to be corrected and/or prevented. 
         [0004]    While cranial bone voids present via congenital deformities or traumatic injuries may be filled using any one or more of the above means to achieve structural soundness, replacement of soft tissue structures that overlie the bone void being filled and underlie adjacent skin tissue generally has to be accounted for in order to achieve a preferable cosmetic result. Bone flaps, standard or customized alloplastic implants, titanium mesh, and liquid methyl methacrylate that are used to fill bone voids do not account for soft tissue atrophy in the temporal area of the skull. Thus, these bone void filling means do not provide an adequate aesthetic reconstruction of this area. 
         [0005]    In many cases where bone is filled in the temporal region, the soft tissue loss in this area generally results in concavity referred to as temporal hollowing. This reflects a deficiency in the bulk of the temporalis muscle or overlying temporal fat pad. Many patients who have undergone neurosurgical procedures that damage the integrity of the temporalis muscle during temporal or pterional craniotomy surgery in the temporal area are left with this concavity. Both aesthetic and reconstructive procedures that violate the temporal fat pad may result in temporal hollowing. As such, the area of concern is a direct deformity related to a few etiologies such as temporalis muscle displacement or foreshortening from previous surgery, temporal fat pad atrophy, or soft tissue contraction from irradiation or aging. 
         [0006]    In patients with the common temporal hollowing, the top or cephalad part of the deformity is generally a concave depression due to the missing, above-mentioned etiologies. In addition, directly underneath and neighboring this concave depression is a convex bulge (directly cephalad to the zygomatic arch) that often originates from a displaced temporalis muscle. In some common instances, the temporalis muscle cannot be re-inserted since the bone flap is unable to be placed back into position, thereby leaving an absent fixation point adjacent the temporal crest. This not only accentuates the neighboring concave deformity above, it sometimes causes dynamic distortion during chewing since the temporalis muscle is involved with mastication. 
         [0007]    Other reasons for the cephalad deficiency, or other head deformities, may entail temporal fat pad wasting, which is a defined layer of anatomical fat between the skin and the skull which adds to the normal bulk of one&#39;s temporal region. It is often a sign of youthfulness. Many patients who have undergone neurosurgical and/or temporal procedures may lose the integrity of the temporalis muscle during temporal or pterional craniotomy surgery. Both aesthetic and reconstructive procedures that violate the temporal fat pad, such as coronal incisional approaches, for instance, may also result in temporal hollowing, which can happen if a surgeon devascularizes the area with dissection or if the area has received irradiation or tissue resection for oncological treatment. 
         [0008]    Numerous techniques have been described to augment the temporal area, including the placement of various standard or customized alloplastic implants, titanium mesh, free fat grafts, dermal grafts, tissue engineered substrates, the injection and onlay of various absorbable and permanent materials, loco-regional flaps, and, in some instances, free tissue transfer with microscopic technique. Temporal augmentation can restore the preoperative appearance of these patients; however, such augmentation is generally performed in a subsequent procedure after an initial procedure of filling a bone void in this area. Thus, these solutions are problematic because a revision surgery is generally required to correct the deformity, and the patient will likely exhibit aesthetic asymmetry prior to the revision surgery. There thus exists a need for a patient-specific cranial implant that provides both bony reconstruction and soft tissue reconstruction such that one or more revision surgeries will generally not be necessary. 
       BRIEF SUMMARY OF THE INVENTION 
       [0009]    As used herein, when referring to bones or other parts of the body, the term “superior” or “cephalad” means upper or top, and the term “inferior” or “caudal” means lower or bottom. The term “posterior” means towards the back of the body, and the term “anterior” means towards the front part of the body or the face. The term “medial” means toward the midline or center of the body, and the term “lateral” means away from the midline or outside of the body. 
         [0010]    The patient-specific, dual-purpose temporal implants of the present invention are designed to fill a void in the skull while also simultaneously augmenting the pterional/temporal area. Preferably, alloplastic material is used in the construction of such patient-specific temporal implants. The mechanical properties of the alloplastic material used to construct these implants will allow them to cover the void and to recreate the soft tissue bulk that is preferably present in the temporal area prior to any injury and/or atrophy occurring in a patient. The patient-specific implants of the present invention are designed to fill a cranial void while also restoring aesthetic symmetry by augmenting the temporal area of the skull to counter temporal hollowing. Therefore, the patient-specific cranial implants of the present invention may be used to replace a bony void left by a craniotomy either as a preemptive or prophylactic solution to addressing aesthetic asymmetry that may occur due to atrophy of temporal muscle or overlying fat pad of the bony void. 
         [0011]    A first aspect of the present invention is a method of designing a patient-specific craniofacial implant for filling a void in a patient&#39;s skull and for simultaneously replacing soft tissue comprises first creating a three dimensional model of the skull having the void, then creating a preliminary implant model configured to replace the void in the skull, and then creating an updated implant model by augmenting an outer contour of the preliminary implant model to account for soft tissue loss or displacement in a temporal area such as the pterional region of the skull overlying at least a portion of the bony void. 
         [0012]    In one embodiment of this first aspect, tomographic images of the skull of the patient are taken in order to create the three dimensional model of the skull including the void. The preliminary model is created by mirroring contralateral bone of the void about a sagittal plane of the patient. If the defect is bilateral, normal variations of soft tissue to hard tissue variance may be assessed by industry standards and utilized for unilateral or bilateral temporal implant fabrication. Such assessments may be made as gender-specific for males and females since they are known to have different gender-specific anthropometrics. 
         [0013]    In another embodiment of this first aspect, creating a three dimensional of the skull having the void may include taking two-dimensional or three-dimensional photographs from various views for confirmation of aesthetic deformity size and/or shape of the void. 
         [0014]    In another embodiment of this first aspect, augmenting the outer contour of the preliminary implant model comprises providing a first cross-sectional view of the preliminary implant model in a coronal plane, providing on the first cross-sectional view a vertical line tangent to a most lateral portion of a zygomatic arch of the skull of the patient, and providing on the first cross-sectional view a contour line from a temporal crest of the skull until the contour line intersects the vertical line tangent to the most lateral portion of the zygomatic arch in the first cross-sectional view, the contour line representing a first portion of the augmented outer contour of the preliminary implant model. 
         [0015]    In yet another embodiment of this first aspect, augmenting the outer contour of the preliminary implant model further comprises providing a second cross-sectional view of the preliminary implant model in a coronal plane, providing on the second cross-sectional view a vertical line tangent to a most lateral portion of a zygomatic arch of the skull of the patient, and providing on the second cross-sectional view a contour line from a temporal crest of the skull until the contour line intersects the vertical line tangent to the most lateral portion of the zygomatic arch in the second cross-sectional view, the contour line representing a second portion of the augmented outer contour of the preliminary implant model. The coronal plane of the first cross-sectional view is more posterior than the coronal plane of the second cross-sectional view. 
         [0016]    In still yet another embodiment of this first aspect, augmenting the outer contour of the preliminary implant occurs in a plurality of cross-sectional views in the coronal plane. 
         [0017]    In still yet another embodiment of this first aspect, augmenting the outer contour of the preliminary implant occurs in a plurality of cross-sectional views in an axial plane. 
         [0018]    In still yet another embodiment of this first aspect, augmenting the outer contour of the preliminary implant occurs in a plurality of cross-sectional views in a sagittal plane. 
         [0019]    In still yet another embodiment of this first aspect, the patient-specific craniofacial implant is manufactured from alloplastic and/or absorbable biologic materials selected from one member of a group consisting of polymethylmethacrylate (PMMA), polyetheretherketone (PEEK), and porous high-density polyethylene (MedPor). Other biologic materials or tissue-engineered substrates may be used in both allograft and xenograft origin using the patient-specific craniofacial implant design processes described herein. 
         [0020]    A second aspect of the present invention is a craniofacial implant comprising a base portion having an outer surface curved in a medial to lateral direction, a superior to inferior direction, and a posterior to anterior direction, and a curved augment portion protruding outwardly from the outer surface of the base portion in the medial to lateral direction to restore proper appearance anywhere along the temporal skeleton when both a hard tissue deformity and soft tissue deformity co-exist. The craniofacial implant of the present invention could also be designed for soft-tissue only defects, providing the surgeon a new method to camouflage assymetries—both from congential and acquired etiologies. 
         [0021]    In one embodiment of this second aspect, the curved augment portion of the craniofacial implant has an outer surface curved in the medial to lateral direction, the superior to inferior direction, and the posterior to anterior direction. 
         [0022]    In another embodiment of this second aspect, the outer surface of the base portion and the augment portion has a first radius of curvature in the medial to lateral direction, and wherein the first radius of curvature of the base portion is larger than the first radius of curvature of the augment portion. 
         [0023]    In yet another embodiment of this second aspect, the outer surface of the base portion and the augment portion has a second radius of curvature in the superior to inferior direction, and wherein the second radius of curvature of the base portion is larger than the second radius of curvature of the augment portion. 
         [0024]    In yet another embodiment of this second aspect, the outer surface of the base portion and the augment portion has a third radius of curvature in the posterior to anterior direction, and wherein the third radius of curvature of the base portion is larger than the third radius of curvature of the augment portion. 
         [0025]    In yet another embodiment of this second aspect, the outer surfaces of the base portion and the augment portion are convex. 
         [0026]    In still yet another embodiment of this second aspect, the base portion and the augment portion each have concave inner surfaces. 
         [0027]    In still yet another embodiment of this second aspect, the base portion has a lateral side that forms a perimeter of the craniofacial implant. 
         [0028]    In still yet another embodiment of this second aspect, the augment portion has a lateral side that forms a portion of a perimeter of the base portion. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0029]    A more complete appreciation of the subject matter of the present invention and the various advantages thereof can be realized by reference to the following detailed description in which reference is made to the accompanying drawings in which: 
           [0030]      FIG. 1A  is a perspective view of a patient&#39;s face exhibiting temporal hollowing in the pterional region of the skull. 
           [0031]      FIG. 1B  is a perspective view of the patient&#39;s face of  FIG. 1A  with a repaired pterional region such that the temporal hollowing has been corrected. 
           [0032]      FIG. 2  is a perspective view of a patient&#39;s skull exhibiting a large bone void predominately positioned in the temporal lobe thereof. 
           [0033]      FIG. 3A  is a frontal view of one embodiment of a patient-specific cranial implant of the present invention designed to fill a bone void in a skull of a patient. 
           [0034]      FIG. 3B  is a lateral view of an outer surface of the patient-specific cranial implant of FIG. A. 
           [0035]      FIG. 3C  is a lateral view of an inner surface of the patient-specific cranial implant of  FIG. 3A . 
           [0036]      FIG. 4A  is a 3D reconstruction of a patient-specific cranial implant of the present invention having filled a void in the skull of a patient, the patient-specific cranial implant having an augmented portion projecting outwardly from a base portion. 
           [0037]      FIG. 4B  is a coronal cross-section of the 3D reconstruction of  FIG. 4A  taken along the section line shown in  FIG. 4A , the cross-section showing the relationship between the base portion and the augmented portion of the patient-specific cranial implant. 
           [0038]      FIG. 5A  is a 3D reconstruction of the patient-specific cranial implant of  FIG. 4A  wherein the augmented portion thereof is shown having an area approximately the area of the box with arrows overlying the implant. 
           [0039]      FIG. 5B  is a coronal cross-section of the 3D reconstruction of  FIG. 5A  taken along line  5 B thereof showing the location of the most lateral portion of the augmented portion of the patient-specific cranial implant. 
           [0040]      FIG. 6A  is a lateral view of the 3D reconstruction of the patient-specific cranial implant. 
           [0041]      FIG. 6B  is a frontal view of the 3D reconstruction of the patient-specific cranial implant shown in  FIG. 6A . 
           [0042]      FIG. 7A  is a lateral view of a 3D reconstruction of another embodiment of a patient-specific cranial implant having a base portion and at least one augmented portion. 
           [0043]      FIG. 7B  is a coronal cross-section of the 3D reconstruction of  FIG. 7A  taken along line  7 B thereof, the cross-section showing the configuration of the base portion and the augmented portion at a posterior location of the pterional region of the skull. 
           [0044]      FIG. 7C  is another lateral view of a 3D reconstruction of the patient-specific cranial implant of  FIG. 7A . 
           [0045]      FIG. 7D  is a coronal cross-section of the 3D reconstruction of  FIG. 7C  taken along line  7 D thereof, the cross-section showing the configuration of the base portion and the augment portion at a central location of the pterional region of the skull. 
           [0046]      FIG. 7E  is yet another lateral view of a 3D reconstruction of the patient-specific cranial implant of  FIG. 7A . 
           [0047]      FIG. 7F  is a coronal cross-section of the 3D reconstruction of  FIG. 7E  taken along line  7 F thereof, the cross-section showing the configuration of the base portion and the augmented portion at an anterior location of the pterional region of the skull. 
           [0048]      FIG. 8A  is a frontal view of a 3D reconstruction of the patient-specific cranial implant shown in  FIG. 7A . 
           [0049]      FIG. 8B  is an axial cross-section of the 3D reconstruction of  FIG. 8A  taken along line  8 B thereof, the cross-section showing the configuration of the base portion and the augmented portion at a superior location of the pterional region of the skull. 
           [0050]      FIG. 8C  is another frontal view of a 3D reconstruction of the patient-specific cranial implant of  FIG. 7A . 
           [0051]      FIG. 8D  is an axial cross-section of the 3D reconstruction of  FIG. 8C  taken along line  8 D thereof, the cross-section showing the configuration of the base portion and the augmented portion at a central location of the pterional region of the skull. 
           [0052]      FIG. 8E  is yet another frontal view of a 3D reconstruction of the patient-specific cranial implant of  FIG. 7A . 
           [0053]      FIG. 8F  is an axial cross-section of the 3D reconstruction of  FIG. 8E  taken along line  8 F thereof, the cross-section showing the configuration of the base portion and the augmented portion at an inferior location of the pterional region of the skull. 
       
    
    
     DETAILED DESCRIPTION 
       [0054]      FIG. 1A  is a perspective view of a patient&#39;s face  100  exhibiting temporal hollowing  120  in the pterional region of the skull of the patient. The size, shape and location of such temporal hollowing of a patient may differ based on patient&#39;s anatomy as well as the type of injury and/or the amount of tissue atrophy incurred by the patient in this region. 
         [0055]      FIG. 1B  is a perspective view of the patient&#39;s face with a repaired pterional region such that the temporal hollowing has been corrected and is no longer present. After an initial surgery to correct a bony void is performed, a subsequent procedure using a pterional graft, PMMA, filler, absorbable material or tissue engineered substrate, for example, may be performed in order to repair the soft tissue defect. The subsequent procedure may be conducted via injection of PMMA percutaneously into this region or by placing a pterional flap through a small incision made in the skin. However, a patient will likely exhibit aesthetic asymmetry between the time of the initial surgery and the subsequent revision surgery to correct the temporal hollowing shown in  FIG. 1A . The patient-specific cranial implants and methods of designing such implants of the present invention together provide simultaneous customized hard tissue (i.e. bony) reconstruction and soft tissue (i.e. fat/muscle) reconstruction in a single procedure approach such that temporal hollowing is avoided and revision procedures will not be required. 
         [0056]      FIG. 2  is a perspective view of a patient&#39;s skull  200  exhibiting a large irregularly shaped bone void  210  predominately positioned in the temporal lobe thereof.  FIGS. 3A-3C  show one embodiment of a patient-specific cranial implant  300  of the present invention designed to fill a bone void, such as shown in  FIG. 2 , for example. Patient-specific cranial implant  300  includes a perimeter  320  configured to contact a perimeter  220  of bone void  210  when patient-specific cranial implant  300  is coupled to bone void  210  in a preoperatively planned position. Upon coupling of patient-specific cranial implant  300  to bone void  210 , plates, fasteners and/or adhesive glue, for example, may be used around perimeters  220 ,  320  of bone void  210  and implant  300 , respectively, in order to fix the position of implant  300  with respect to bone void  210 . A description of such plates and fasteners used to couple a patient-specific implant to a perimeter of a bone void is shown and described in the surgical protocol titled “Stryker CMF Customized Implant PEEK,” the disclosure of which is incorporated by reference herein in its entirety. 
         [0057]    Implant  300  includes a base portion  340  and an augment portion  360 . Base portion  340  includes a convex outer surface  342  and a concave inner surface  344 . Outer and inner surfaces  342 ,  344  of base portion  340  are preferably curved in a superior to inferior direction, a posterior to anterior direction, and a medial to lateral direction. Augment portion  360  protrudes outwardly from base portion  340  in the medial to lateral direction. Augment portion  360  includes a convex outer surface  362  that is also preferably curved in the superior to inferior direction, the posterior to anterior direction, and the medial to lateral direction. 
         [0058]    Base portion  340  and augment portion  360  each have a first radius of curvature in the superior to inferior direction, a second radius of curvature in the posterior to anterior direction and a third radius of curvature in the medial to lateral direction. The first, second and third radii of curvature of the base portion  340  are all larger than the first, second and third radii of curvature of the augment portion  360 , respectively. Therefore, base portion  340  is flatter and not as steeply shaped as augment portion  360 . The radii of curvature are generally not constant along any one direction for each of the base portion  340  and augment portion  360 . 
         [0059]    Augment portion  360  has a lateral side  370  that preferably forms a portion of a perimeter  350  of base portion  340 . The location of augment portion  360  with respect to base portion  360  is such that lateral side  370  of augment portion  360  preferably forms a portion of perimeter  320  of implant  300  along with perimeter  350  of base portion  340 . 
         [0060]    When cranial implant  300  is implanted, the most lateral portion of outer surface  362  of augment portion  360  is preferably located on a line tangent to the most lateral portion of the zygomatic arch, the line being substantially parallel to the sagittal plane of the patient. Augment portion  360  also extends as far posteriorly as it does superiorly so that an area of augment portion is roughly square. 
         [0061]    A method of designing a patient-specific craniofacial implant, such as cranial implant  300 , for filling a void in a skull of a patient and for replacing soft tissue is shown in  FIGS. 4A-6B . A tomographic scan such as a computed tomography (“CT”) scan of a patient with a lateral cranial defect that fully or partially extends into the pterional region of the skull is first taken. Off the shelf CT segmentation software is then used to create a three dimensional (“3D”) model of the patient&#39;s cranium including the lateral cranial defect. A patient-specific craniofacial implant is then designed using computer aided design (“CAD”) software. The patient-specific 3D implant will fill the bony void left by a craniotomy, for example, and also augment the visible temporal portions of the patient&#39;s head. 
         [0062]    Using the CAD software, a preliminary implant model  400  is designed by mirroring contralateral bone of the lateral cranial defect. Generally, the contralateral bone is mirrored off of the central sagittal plane  410  as shown in  FIG. 4B  of a patient&#39;s skull in order to define the size, shape and location of preliminary implant model  400  with respect to the cranial defect. Models of deformed or missing segments of internal structures, such as a lateral cranial defect, may also be constructed from coordinate data specifying the deformed or missing segment that is derived from representations of a normal mirror image segment of the structure. For example, coordinate data defining a mirror image segment of a structure is useful in the construction of an implantable prosthetic inlay that is to replace a missing segment of a generally symmetrical internal anatomic structure as shown and described in U.S. Pat. No. 4,436,684 to White entitled, “Method of Forming Implantable Prosthesis for Reconstructive Surgery,” the disclosure of which is hereby incorporated by reference in its entirety. In instances where bilateral deformities exist, the dual-purpose implants of the present invention may be at least partly designed using standard gender-specific dimensions. 
         [0063]    While preliminary implant model  400  may be designed using any one or more of the above described methods, it represents a traditional customized implant that does not account for soft tissue in the pterional/temporal region. In a method of the present invention, preliminary implant model  400  is used as a guide during subsequent design steps. The outer contour  420  of preliminary implant model  400  is augmented in order to account for the soft tissue loss. 
         [0064]    Preliminary implant model  400  is designed to have a perimeter that contacts the entire perimeter of the bone void. Augment portion  500  is designed to augment the pterion in order to counter the effects of temporal hollowing. Careful attention is made not to include excess material inferiorly which may contribute to mandibular interference known as trismus. The CT coronal cross section of  FIG. 4B  shows the difference between preliminary implant model  400  and an updated implant model including augment portion  500 . In some design processes, augment portion  500  may only project outwardly from preliminary implant model  400  such that it does not span the entire length of a bone void, and therefore does not contact the entire perimeter of the bone void as does the preliminary implant model. As can be seen in  FIG. 4B , for example, augment portion  500  is not symmetric to contralateral bone as is preliminary implant model  400 . Together, preliminary implant model  400  and augment portion  500  form an updated implant model  600  as shown in  FIG. 4A . Preliminary implant model  400  has a first volume and augment portion  500  has an additional volume. With the addition of the volume of augment portion  500  to the first volume of preliminary implant model  400 , updated implant model  600  therefore has a second volume greater than the first volume. This figure also includes a directional legend with arrows in three dimensions. S, I, M, L, P and A on this legend, and any other legend in the drawings, stand for superior, inferior, medial, lateral, posterior and anterior, respectively. Most of the bulk reproduction of the soft tissue in the pterion region, which is represented by augment portion  500 , occurs at the anterior, lateral, inferior portion of the temporal skull. 
         [0065]    In determining the location of the most lateral portion of the outer surface of augment portion  500 , the preliminary implant model  400  is extended laterally away from sagittal plane  410 , for example, until the outer surface of augment portion  500  meets the most lateral portion of the zygomatic arch  550  of the patient as shown in  FIG. 5B . The most lateral portion of the zygomatic arch is depicted by vertical line  540  in the coronal cross section shown in  FIG. 5B . In the coronal plane, the temporal region of the preliminary implant model is augmented by drawing a substantially straight or slightly curved line  560  from the temporal crest  530  until line  560  intersects vertical line  540  adjacent the most lateral portion of the zygomatic arch  550 . Temporal crest  530  is located at the point where there is a change in tangency of the pterional skull as pertinent in the present scenario. Of note, various other areas of the temporal (i.e. pterional) skeleton could be assessed for dual-purpose reconstruction. This process is preferably repeated in several different two dimensional (“2D”) coronal cross-sections. The updated implant models created in the 2D cross-sections are then combined using the CT segmentation software in order to create the 3D updated implant model shown in  FIGS. 6A-6B , for example. 
         [0066]    As shown in  FIGS. 6A-6B , augment portion  500  extends posteriorly from the lateral orbital rim  575  to a vertical line  580  perpendicular to the sagittal plane drawn through the external acoustic meatus  585 . Augment portion  500  should extend as far posteriorly as it does superiorly so that the augmented area is roughly square as shown in  FIG. 5A . The augmented area is roughly outlined by box  570  overlying updated implant model  600  in  FIG. 5A . 
         [0067]      FIGS. 7A ,  7 C, and  7 E are a series of lateral views of a 3D reconstruction of one embodiment of an updated implant model  600  implanted in a model of a bone void of a patient&#39;s skull  610 , each of these views including a section line  7 B,  7 D, and  7 F, respectively. Section lines  7 B,  7 D, and  7 F are each situated at different locations on the 3D models. Section line  7 B is located in a posterior region, section line  7 D is located in a central region, and section line  7 F is located in an anterior aspect of the pterional region of the patient&#39;s skull  610  in these lateral views.  FIGS. 7B ,  7 D and  7 F are coronal cross-sectional views that correspond to  FIGS. 7A ,  7 C and  7 E, respectively. Each of these coronal cross-sectional views show updated implant model  600  including a preliminary implant model  700  and an augment portion  800 . As can be seen most clearly in  FIG. 7D , augment portion  800  is not symmetric to contralateral bone as is preliminary implant model  700 . Most of the bulk reproduction of augment portion  800  is created in this central region of the pterion. 
         [0068]      FIGS. 8A ,  8 C, and  8 E are a series of frontal views of updated implant model  600  each having a section line  8 B,  8 D, and  8 F, respectively. Section lines  8 B,  8 D, and  8 F are each situated at different locations on the 3D models. Section line  8 B is located in a superior region, section line  7 D is located in a central region, and section line  8 F is located in an inferior aspect of the pterional region of the patient&#39;s skull in these lateral views.  FIGS. 8B ,  8 D and  8 F are axial cross-sectional views that correspond to  FIGS. 8A ,  8 C and  8 E, respectively. Each of these axial cross-sectional views shows the difference between preliminary implant model  700  and an updated implant model including augment portion  800 . As can be seen most clearly in  FIG. 8D , augment portion  800  is not symmetric to contralateral bone as is preliminary implant model  700 . It is designed and modified specifically to make up for the soft tissue discrepancy. In other words, it can be used for deformity prophylaxis and/or secondary correction. 
         [0069]    Each patient-specific cranial implant of the present invention will be customized to fit the unique bony void and individual anthropometry of the patient, and therefore, the design inputs described above may be adjusted as needed. For example, with respect to bilateral deficits, the dual-purpose implants can be fabricated used gender-specific anthropometric norms. Once the design of updated implant model  600  is finalized using the CAD software, a patient-specific craniofacial implant may be manufactured using any one of many known manufacturing techniques, such as steriolithography, milling, and molding, for example. The implant can then be manufactured, for example, from alloplastic materials such as PMMA, MEDPOR®, and PEEK. 
         [0070]    Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is, therefore, to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.