The Current Role of Three-Dimensional Printing in Plastic Surgery:

Craniofacial Reconstruction by a Cost-Efficient Template-Based Process Using 3D Printing

Craniofacial defects often result in aesthetic and functional deficits, which affect the patient’s psyche and wellbeing. Patient-specific implants remain the optimal solution, but their use is limited or impractical due to their high costs. This article describes a fast and cost-efficient workflow of in-house manufactured patient-specific implants for craniofacial reconstruction and cranioplasty. As a proof of concept, we present a case of reconstruction of a craniofacial defect with involvement of the supraorbital rim. The following hybrid manufacturing process combines additive manufacturing with silicone molding and an intraoperative, manual fabrication process. A computer-aided design template is 3D printed from thermoplastics by a fused deposition modeling 3D printer and then silicone molded manually. After sterilization of the patient-specific mold, it is used intraoperatively to produce an implant from polymethylmethacrylate. Due to the combination of these 2 straightforward processes, the procedure can be kept very simple, and no advanced equipment is needed, resulting in minimal financial expenses. The whole fabrication of the mold is performed within approximately 2 hours depending on the template’s size and volume. This reliable technique is easy to adopt and suitable for every health facility, especially those with limited financial resources in less privileged countries, enabling many more patients to profit from patient-specific treatment.

A guide for effective anatomical vascularization studies: useful ex vivo methods for both CT and MRI imaging before dissection

The objective of this study was to develop a simple and useful injection protocol for imaging cadaveric vascularization and dissection. Mixtures of contrast agent and cast product should provide adequate contrast for two types of ex vivo imaging (MRI and CT) and should harden to allow gross dissection of the injected structures. We tested the most popular contrast agents and cast products, and selected the optimal mixture composition based on their availability and ease of use. All mixtures were first tested in vitro to adjust dilution parameters of each contrast agent and to fine-tune MR imaging acquisition sequences. Mixtures were then injected in 24 pig livers and one human pancreas for MR and computed tomography (CT) imaging before anatomical dissection. Colorized latex, gadobutrol and barite mixture met the above objective. Mixtures composed of copper sulfate (CuSO₄ ) gadoxetic acid (for MRI) and iodine (for CT) gave an inhomogeneous signal or extravasation of the contrast agent. Agar did not harden sufficiently for gross dissection but appears useful for CT and magnetic resonance imaging (MRI) studies without dissection. Silicone was very hard to inject but achieved the goals of the study. Resin is particularly difficult to use but could replace latex as an alternative for corrosion instead of dissection. This injection protocol allows CT and MRI images to be obtained of cadaveric vascularization and anatomical casts in the same anatomic specimen. Post-imaging processing software allow easy 3D reconstruction of complex anatomical structures using this technique. Applications are numerous, e.g. surgical training, teaching methods, postmortem anatomic studies, pathologic studies, and forensic diagnoses.

Patient-Specific Augmentation Rhinoplasty Using a Three-Dimensional Simulation Program and Three-Dimensional Printing

Background

The convergence of three-dimensional (3D) simulation, tissue engineering, and 3D printing technology is creating a paradigm shift in plastic surgery. In augmentation rhinoplasty, determining the ideal material and design method has been a critical issue for many years. Thus, these technologies are expected to make important contributions to augmentation rhinoplasty.

Objectives

We sought to validate the feasibility of the 3D carving simulation and patient-specific implant fabrication system (3D carving system) in a clinical trial using reproducibility tests.

Methods

Patient-specific implants were designed using a program developed in-house with preoperative computed tomography (CT). Negative molds of the implant were fabricated by a 3D printer and silicone was injected into these molds. Ten actual silicone implants were fabricated and compared with virtually designed implants. Seven patients underwent surgery and postoperative CT to confirm implant positioning.

Results

Virtually designed implants were produced into actual implants within 0.07 mm with a 0.17% ± 0.11% difference. The percentage within the gap was the highest at the cephalic end of the implant and reduced from the cephalic to caudal end (most cephalic point: 100%; rightmost and leftmost point of the implant at the caudal end of the nasal bone: 57.1% and 71.4%, respectively; rightmost and leftmost point at the supratip break: 28.6% and 28.6%, respectively; and most caudal point: 0%).

Conclusions

The 3D carving system can facilitate rhinoplasty by enabling the more intuitive, rapid, and accurate fabrication of implants irrespective of surgeon experience level.

Level of Evidence

4.

[Application progress of digital technology in auricle reconstruction]

Objective

To review the application progress of digital technology in auricle reconstruction.

Methods

The recently published literature concerning the application of digital technology in auricle reconstruction was extensively consulted, the main technology and its specific application areas were reviewed.

Results

Application of digital technology represented by three-dimensional (3D) data acquisition, 3D reconstruction, and 3D printing is an important developing trend of auricle reconstruction. It can precisely guide auricle reconstruction through fabricating digital ear model, auricular guide plate, and costal cartilage imaging.

Conclusion

Digital technology can improve effectiveness and decrease surgical trauma in auricle reconstruction. 3D bioprinting of ear cartilage future has bright prospect and needs to be further researched.

Quantitative evaluation of performance of 3D printed lenses

We present an analysis of the shape, surface quality, and imaging capabilities of custom 3D printed lenses. 3D printing technology enables lens prototypes to be fabricated without restrictions on surface geometry. Thus, spherical, aspherical and rotationally non-symmetric lenses can be manufactured in an integrated production process. This technique serves as a noteworthy alternative to multistage, labor-intensive, abrasive processes such as grinding, polishing and diamond turning. Here, we evaluate the quality of lenses fabricated by Luxexcel using patented Printoptical© technology that is based on an inkjet printing technique by comparing them to lenses made with traditional glass processing technologies (grinding, polishing etc.). The surface geometry and roughness of the lenses were evaluated using white-light and Fizeau interferometers. We have compared peak-to-valley wavefront deviation, root-mean-squared wavefront error, radii of curvature and the arithmetic average of the roughness profile (Ra) of plastic and glass lenses. Additionally, the imaging performance of selected pairs of lenses was tested using 1951 USAF resolution target. The results indicate performance of 3D printed optics that could be manufactured with surface roughness comparable to that of injection molded lenses (Ra < 20 nm). The RMS wavefront error of 3D printed prototypes was at a minimum 18.8 times larger than equivalent glass prototypes for a lens with a 12.7 mm clear aperture, but when measured within 63% of its clear aperture, 3D printed components' RMS wavefront error was comparable to glass lenses.

Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note

Repeat surgery for restenosis after initial nonsyndromic craniosynostosis intervention is sometimes needed. Calvarial vault reconstruction through a healed surgical bed adds a level of intraoperative complexity and may benefit from preoperative and intraoperative definitions of biometric and aesthetic norms. Computer-assisted design and manufacturing using 3D imaging allows the precise formulation of operative plans in anticipation of surgical intervention. 3D printing turns virtual plans into anatomical replicas, templates, or customized implants by using a variety of materials. The authors present a technical note illustrating the use of this technology: a repeat calvarial vault reconstruction that was planned and executed using computer-assisted design and 3D printed intraoperative guides.

Medical 3D printing: methods to standardize terminology and report trends

Background

Medical 3D printing is expanding exponentially, with tremendous potential yet to be realized in nearly all facets of medicine. Unfortunately, multiple informal subdomain-specific isolated terminological ‘silos’ where disparate terminology is used for similar concepts are also arising as rapidly. It is imperative to formalize the foundational terminology at this early stage to facilitate future knowledge integration, collaborative research, and appropriate reimbursement. The purpose of this work is to develop objective, literature-based consensus-building methodology for the medical 3D printing domain to support expert consensus.

Results

We first quantitatively survey the temporal, conceptual, and geographic diversity of all existing published applications within medical 3D printing literature and establish the existence of self-isolating research clusters. We then demonstrate an automated objective methodology to aid in establishing a terminological consensus for the field based on objective analysis of the existing literature. The resultant analysis provides a rich overview of the 3D printing literature, including publication statistics and trends globally, chronologically, technologically, and within each major medical discipline. The proposed methodology is used to objectively establish the dominance of the term “3D printing” to represent a collection of technologies that produce physical models in the medical setting. We demonstrate that specific domains do not use this term in line with objective consensus and call for its universal adoption.

Conclusion

Our methodology can be applied to the entirety of medical 3D printing literature to obtain a complete, validated, and objective set of recommended and synonymous definitions to aid expert bodies in building ontological consensus.

Electronic supplementary material

The online version of this article (doi:10.1186/s41205-017-0012-5) contains supplementary material, which is available to authorized users.

3D Printed Models of Cleft Palate Pathology for Surgical Education

To explore the potential viability and limitations of 3D printed models of children with cleft palate deformity.

BACKGROUND

The advantages of 3D printed replicas of normal anatomical specimens have previously been described. The creation of 3D prints displaying patient-specific anatomical pathology for surgical planning and interventions is an emerging field. Here we explored the possibility of taking rare pediatric radiographic data sets to create 3D prints for surgical education.

METHODS

Magnetic resonance imaging data of 2 children (8 and 14 months) were segmented, colored, and anonymized, and stereolothographic files were prepared for 3D printing on either multicolor plastic or powder 3D printers and multimaterial 3D printers.

RESULTS

Two models were deemed of sufficient quality and anatomical accuracy to print unamended. One data set was further manipulated digitally to artificially extend the length of the cleft. Thus, 3 models were printed: 1 incomplete soft-palate deformity, 1 incomplete anterior palate deformity, and 1 complete cleft palate. All had cleft lip deformity. The single-material 3D prints are of sufficient quality to accurately identify the nature and extent of the deformities. Multimaterial prints were subsequently created, which could be valuable in surgical training.

CONCLUSION

Improvements in the quality and resolution of radiographic imaging combined with the advent of multicolor multiproperty printer technology will make it feasible in the near future to print 3D replicas in materials that mimic the mechanical properties and color of live human tissue making them potentially suitable for surgical training.