Computer-aided methods for single-stage fibrous dysplasia excision and reconstruction in the zygomatico-orbital complex

Abstract

Purpose Computer-aided design and additive manufacture (CAD/AM) technologies are sufficiently refined and meet the necessary regulatory requirements for routine incorporation into the medical field, with long-standing application in surgeries of the maxillofacial and craniofacial regions. They have resulted in better medical care for patients and faster, more accurate procedures. Despite ever-growing evidence about the advantages of computer-aided planning, CAD and AM in surgery, detailed reporting on critical design decisions that enable methodological replication and the development and establishment of guidelines to ensure safety are limited. This paper aims to present a novel application of CAD and AM to a single-stage resection and reconstruction of fibrous dysplasia in the zygoma and orbit. Design/methodology/approach It is reported in sufficient fidelity to permit methods replication and design guideline developments in future cases, wherever they occur in the world. The collaborative approach included engineers, designers, surgeons and prosthetists to design patient-specific cutting guides and a custom implant. An iterative design process was used, until the desired shape and function were achieved, for both of the devices. The surgery followed the CAD plan precisely and without problems. Immediate post-operative subjective clinical judgements were of an excellent result. Findings At 19 months post-op, a CT scan was undertaken to verify the clinical and technical outcomes. Dimensional analysis showed maximum deviation of 4.73 mm from the plan to the result, while CAD-Inspection showed that the deviations ranged between −0.1 and −0.8 mm and that the majority of deviations were located around −0.3 mm. Originality/value Improvements are suggested and conclusions drawn regarding the design decisions considered critical to a successful outcome for this type of procedure in the future.

Accuracy of 3D printed guide for orbital implant

“…The implant must, therefore, be fitted to the patient-specific shape of the fracture. This need has led to the adoption of 3D printing techniques, which have been previously used in various medical fields such as personalized simulators, surgical guides and patient-specific implants (Rengier et al, 2010;Kim et al, 2016;Burton et al, 2018;Mandolini, 2019;Budak, 2019).…”

Identifying research and development priorities for an in-hospital 3D design engineering facility in India

“…These include 3D scanning, 3D computer aided planning of surgical procedures, 3D Computer Aided Design (CAD) of medical devices and 3D printing (also known as additive manufacture). Typical applications include the production of patient-specific anatomical models, transient use guides to aid cutting/drilling and osteotomy procedures, production of long-term implants and extra-oral maxillofacial prostheses made specifically for a named patient (Bibb et al, 2010;Budak et al, 2018;Chandra et al, 2005;Eggbeer et al, 2012;Mankovich et al, 1990;Salmi et al, 2012). 3D technologies have also been applied to the development of facial burn/injury splints to compress hypertropic scar tissue and reduce its prominence over time (Pilley et al, 2011;Visscher et al, 2018).…”