Precision Rhinoplasty and Microtia Reconstruction Using Virtual Surgical Planning and Departmentally Manufactured, 3D-Printed, Sterilizable, Patient-Specific Anatomic Models
Lukasz Witek, MSci, PhD1,2, Samantha G. Maliha, BA3,4, Hannah Liss, BA1,2, Jonathan M. Bekisz, BA3,4, Aiza Hamayun, BA1,2, Kimberly Khouri, BA3,4, Samuel Raffaelli, BA1,2, Paulo G. Coelho, DDS, PhD1,2, Roberto L. Flores, MD4.
1New York University College of Dentistry, New York, NY, USA, 2New York University College of Dentistry, Department of Biomaterials, New York, NY, USA, 3New York University School of Medicine, New York, NY, USA, 4New York University Langone Health, Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA.
PURPOSE: Through the implementation of 3D-printed models in the operating room, plastic surgeons are able to visualize and reconstruct key anatomical features during 3-dimensionally intricate procedures.. Sterilizable, patient-specific 3D-printed models can be invaluable in preoperative planning, patient communication, and surgical performance however the current price of commercially manufactured models may reach several thousand dollars. This prohibitive price point has limited widespread application of these constructs. Our simulation team has developed an affordable, reproducible protocol for rapid in-house virtual surgical planning and subsequent manufacture of 3D-printed rhinoplasty and microtia models using departmentally available resources.
METHODS: 3D digital photographic images (3dMD, Atlanta, GA) of a patient’s face and cranium are taken and converted to sterolithography (.stl) files. The images are uploaded to a freely available 3D imaging platform, BlenderTM (Version 2.78, Amsterdam, The Netherlands). Utilizing functions available within Blender, we perform either virtual rhinoplasty or auricular reconstruction. Virtual rhinoplasty includes lowering the dorsum, straightening of the upper and middle vault, infracture, medialization of the alar base, columellar lengthening/straightening, superior rotation of the depressed lower lateral cartilage, tip refinement, and alteration of nasal tip rotation/projection. In virtual microtia, the contralateral ear is inverted along the vertical axis to create a working template for the affected ear. Then, the depths of the scapha, triangular fossa, and cymba are deepened to accentuate contours. The final template for the ear is digitally separated to create the requisite components for the Nagata technique: helix, antihelical fold with the superior and inferior crus, and base frame. The 3D reconstructions are manufactured in-house by a departmentally-owned 3D printer (Builder Premium 3D Printer, Noordwijkerhout, The Netherlands) and white polylactic acid (PLA) filament (Batch #: 15099905; Builder Premium 3D Printer, Noordwijkerhout, The Netherlands). Upon completion, these models are sterilized according to a low temperature protocol (121° C for 60 minutes followed by 30 minutes dry cycle) set forth by the manufacturer and brought into the operating room, where they are available to the surgeon throughout the procedure.
RESULTS: Ten patients have undergone rhinoplasty, and three patients have undergone microtia reconstruction using virtual surgical planning and departmentally manufactured, sterilizable, patient-specific 3D printed models. Digital models were available to the surgeon preoperatively for review of treatment plan with the patient and confirmation of operative approach. Nose and ear models required 5 and 4 hours, respectively, of digital preparation/sculpting time. Manufacturing averaged 22 and 7 hours of 3D printing time for nose and ear models, respectively. The materials cost of each pair of pre- and post-operative models was $4.00.
CONCLUSION: We present a protocol for virtual surgical planning and in-house manufacturing of sterilizable, scaled, patient-specific, 3D printed models. This technique can be affordably reproduced within other academic centers to assist in patient education, preoperative planning, and technical execution of this challenging procedure.
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