Abstract: Mandibular Reconstruction Using Cost-Effective Three-Dimensional Printing

Abstract

INTRODUCTION: There has been an increasing interest in the applications of three-dimensional (3D) printing in plastic surgery.1,2 A physical 3D model provides visualization of complex defects that supersede digital imaging and can be used as a template for preoperative planning and surgical education.3,4With the advent of affordable quality and reliable printers, office-based 3D printing has become possible. We describe our experience with office-based 3D printing in the management of comminuted mandible fractures. The distorted topography of the bony surface and instability of fracture fragments can lead to suboptimal reduction, and shaping of the plate to contour the fracture can be challenging in the operating room. We used a 3D printed model of the patient’s mandible to bend plates preoperatively in order to achieve an ideal plate shape and thus optimum bony reduction. METHODS: Patients diagnosed with a comminuted mandible fracture at R Adams Cowley Shock Trauma Center were identified. Patient’s maxillofacial CT scan DICOM images were uploaded into 3D Slicer (www.slicer.org) and a 3D image model of the mandible was generated using a threshold segmentation technique. The model image was uploaded into Netfabb (Autodesk, San Rafael, CA) and the non-fractured side was mirrored to replace the comminuted side. The final model image was uploaded into Cura software (Ultimaker, Geldermalsen, Netherlands) and the 3D model was printed using a LulzBot TAZ 6 3D printer (Aleph Objects, Loveland, CO) and a 2 millimeter Polylactic acid filament. Titanium plates were then pre-bent according to the 3D printed mandible model and autoclaved in standard fashion prior to use in the operating room. Proper fracture reduction was evaluated with a postoperative CT scan. RESULTS: Three patients with comminuted mandible fractures had a 3D model of their mandible printed preoperatively. Average print time was 6 hours. Excluding the one-time cost of the 3D printer of $2,500, the average materials cost to print one mandible was $4.20. All three patients had successful placement of the titanium plates which were pre-bent preoperatively according to the 3D model. Postoperative CT imaging demonstrated adequate reduction in all three cases. CONCLUSION: Office-based three-dimensional printing is feasible and affordable. We demonstrated how 3D printed models of comminuted mandibular fractures can optimize fracture reduction by preoperatively bending plates. Reference Citations: 1. Choi JW, Kim N. Clinical application of three-dimensional printing technology in craniofacial plastic surgery. Arch Plast Surg. 2015;42(3):267–277. 2. Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging Applications of Bedside 3D Printing in Plastic Surgery. Front Surg. 2015;2(June):25. 3. Numajiri T, Nakamura H, Sowa Y, Nishino K. Low-cost Design and Manufacturing of Surgical Guides for Mandibular Reconstruction Using a Fibula. Plast Reconstr Surg - Glob Open. 2016;4(7):e805. 4. Lioufas PA, Quayle MR, Leong JC, McMenamin PG. 3D Printed Models of Cleft Palate Pathology for Surgical Education. Plast Reconstr surgery Glob open. 2016;4(9):e1029.