Design and fabrication of a generic 3D-printed silicone unilateral cleft lip and palate model

Three-Dimensional Printing in Surgical Education: An Updated Systematic Review of the Literature

INTRODUCTION

Three-dimensional printing (3DP) is being integrated into surgical practice at a significant pace, from preprocedural planning to procedure simulation. 3DP is especially useful in surgical education, where printed models are highly accurate and customizable. The aim of this study was to evaluate how 3DP is being integrated most recently into surgical residency training.

METHODS

We performed a structured literature search of the OVID/MEDLINE, EMBASE, and PUBMED databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles published from 2016 to 2023 that met predefined inclusion and exclusion criteria were included. Data extracted included surgical subspecialty using 3DP, application of 3DP, and any reported satisfaction measures of trainees. A thorough analysis of pooled data was performed to evaluate satisfaction rates among studies.

RESULTS

A total of 85 studies were included. The median number of participants was 18 (interquartile range 10-27). Fourteen surgical disciplines were represented, with ear, nose, and throat/otolaryngology having the highest recorded utilization of 3DP models among residents and medical students (22.0%), followed by neurosurgery (14.0%) and urology (12.0%). 3DP models were created most frequently to model soft tissue (35.3%), bone (24.7%), vessel (14.1%), mixed (16.4%), or whole organs (6.66%) (Fig.1). Feedback from trainees was overwhelmingly positive regarding the fidelity of the models and their support for integration into their training programs. Among trainees, the combined satisfaction rate with their use in the curriculum was 95% (95% confidence interval, 0.92-0.97), and the satisfaction rate with the model fidelity was 90% (95% confidence interval, 0.86-0.94).

CONCLUSIONS

There is wide variation in the surgical specialties utilizing 3DP models in training. These models are effective in increasing trainee comfort with both common and rare scenarios and are associated with a high degree of resident support and satisfaction. Plastic surgery programs may benefit from the integration of this technology, potentially strengthening future surgical curricula. Objective evaluations of their pedagogic effects on residents are areas of future research.

Design and fabrication of silicone cleft lip simulation model for personalized surgical training

PURPOSE OF THE STUDY

To elucidate the design and fabrication methodologies employed in creating a personalized cleft lip simulation model, primarily intended for enhancing surgical training and diverse applications. The study further sought to assess the viability of integrating this simulation model into undergraduate oral experiments and instructional settings.

STUDY DESIGN

Facial data from individuals with cleft lip conditions were acquired using a scanner. Subsequent stages involved reverse engineering and the utilization of 3D printing technology to generate a cleft lip silicone simulation model. The molding process entailed injecting silicone into a polylactic acid mold. The study enrolled 53 undergraduate students majoring in dentistry, who were randomly assigned to either a control or experimental group. A dedicated instructor guided each group independently, employing a combination of multiple-choice tests and surveys to gauge real-time evaluations and discern inter-group disparities.

RESULTS AND CONCLUSIONS

We successfully designed and produced a personalized cleft lip simulation model, demonstrating notable efficacy in the context of cleft lip experimental teaching. Statistical analysis revealed a significant difference (P < 0.05) in the scores of the experimental group students on multiple-choice questions pertaining to cleft lip surgical procedures. Survey outcomes indicated that the experimental group students exhibited higher confidence levels in cleft lip surgery, as reflected from their responses to relevant questions, compared to the traditional group students. These differences were statistically significant (P < 0.05). The simulation model developed in this study emerges as a reliable and cost-effective training and teaching tool for cleft lip surgery.

Application of 3D Printing in Cleft Lip and Palate Repair

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

Cleft lip and palate surgery simulator: Open source simulation model

Objective

Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques.

Design

The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue.

Setting

Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training.

Results

More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair.

Conclusion

This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.

Six-year Burden of Care for Nonsyndromic Unilateral Cleft Lip and Palate Patients: A Comparison Between Cleft Centers and Noncleft Centers

OBJECTIVE

To determine differences in burden of care between nonsyndromic patients with unilateral cleft lip and palate undergoing treatment at American Cleft Palate-Craniofacial Association (ACPA)-accredited centers and nonaccredited centers in New York State.

DESIGN

A retrospective review of the New York Statewide Planning and Research Cooperative System database from January 2001 to December 2014 was performed using ICD-9 and CPT coding.

PATIENTS, PARTICIPANTS

This study included patients with unilateral cleft lip and palate who underwent both lip and palate repairs during their first  6 years of life. Exclusion criteria included orofacial cleft syndromes, follow-up under  6 years, and one-stage combined cleft lip and palate repairs.

RESULTS

Eighty-eight patients were treated at cleft centers, and 29 patients at nonaccredited centers (  n = 117). Age at primary palatoplasty (13.0 months vs 18.1 months;   p = .019), total number of cleft operations (2.3 vs 2.7;   p = .012), and total number of primary cleft-specific procedures (2.2 vs 2.5;   p = .0049) were significantly lower for patients treated in cleft centers. Age at primary cheiloplasty (4.8 months vs 4.6 months;   p = .865), post-cheiloplasty length of stay (1.2 days vs 1.2 days;   p = .673), post-palatoplasty length of stay (1.5 days vs 1.9 days;   p = .211), average hospital admissions (2.2 vs 2.3; p = 0.161), and total complication rates (34.1% vs 21.1%; p = 0.517) did not differ significantly between cleft centers and noncenters.

CONCLUSIONS

This data demonstrates some significant differences in overall 6 year burden of care for nonsyndromic patients with unilateral cleft lip and palate treated at ACPA-accredited cleft centers versus nonaccredited centers.

Simulation in plastic and reconstructive surgery: a scoping review

Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.

A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.

Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.

Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.

This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.

Needle penetration test - qualifying examination of 3D printable silicones for vascular models in surgical practice

Background

During cardiogenic shock blood circulation is minimal in the human body and does not suffice to survive. The extracorporeal life support system (ECLS) acts as a miniature heart-lung-machine that can be temporarily implanted over major vessels e.g. at the groin of the patient to bridge cardiogenic shock. To perform this procedure in an emergency, a proper training model is desirable. Therefore, a 3-dimensional-printable (3D) material must be found that mimics large vessel needle penetration properties. A suitable test bench for material comparison is desirable.

Methods

A test setup was built, which simulated the clinically relevant wall tension in specimens. The principle was derived from an existing standardized needle penetration test. After design, the setup was fabricated by means of 3D printing and mounted onto an universal testing machine. For testing the setup, a 3D printable polymer with low Shore A hardness and porcine aorta were used. The evaluation was made by comparing the curves of the penetration force to the standardized test considering the expected differences.

Results

3D printing proved to be suitable for manufacturing the test setup, which finally was able to mimic wall tension as if under blood pressure and penetration angle. The force displacement diagrams showed the expected curves and allowed a conclusion to the mechanical properties of the materials. Although the materials forces deviated between the porcine aorta and the Agilus30 polymer, the graphs showed similar but still characteristic curves.

Conclusions

The test bench provided the expected results and was able to show the differences between the two materials. To improve the setup, limitations has been discussed and changes can be implemented without complications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41205-021-00110-y.