fig1 a 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 . fig1 b 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 fig1 a . 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 . fig2 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 . fig3 a - 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 fig2 , 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 . 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 . 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 . 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 . 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 . 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 fig4 a - 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 . 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 fig4 b 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 . 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 . 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 fig4 b 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 fig4 b , 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 fig4 a . 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 . 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 fig5 b . the most lateral portion of the zygomatic arch is depicted by vertical line 540 in the coronal cross section shown in fig5 b . 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 fig6 a - 6b , for example . as shown in fig6 a - 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 fig5 a . the augmented area is roughly outlined by box 570 overlying updated implant model 600 in fig5 a . fig7 a , 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 . fig7 b , 7 d and 7 f are coronal cross - sectional views that correspond to fig7 a , 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 fig7 d , 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 . fig8 a , 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 . fig8 b , 8 d and 8 f are axial cross - sectional views that correspond to fig8 a , 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 fig8 d , 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 . 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 . 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 .
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 .