Reconstruction of an Extensive Midfacial Defect Using Additive Manufacturing Techniques

Abstract

Malignant peripheral nerve sheath tumours are extremely rare tumours arising in peripheral nerves. Only 17 cases involving the trigeminal nerve have ever been reported. These tumours have a very poor prognosis and very high rates of recurrence and metastases. Their recommended treatment involves complete tumour resection followed by radiation. This can be problematic in the head and neck region. We present a clinical case involving a 33 year old female patient presenting with a slow growing exophytic mass of the anterior maxilla.Incisional biopsy and subsequent histological examination revealed a diagnosis of a malignant peripheral nerve sheath tumour. Surgical resection involved a complete maxillectomy, rhinectomy, and resection of the upper lip and aspects of the left and right cheeks. Reconstruction of the subsequent defect incorporated the placement of 4 zygomatic oncology implants to aid in retention of a facial prosthesis. These implants, however, were subsequently lost so it was decided to manufacture an anatomical model of the hard tissues via 3D printing. This model was used to design and manufacture a titanium frame (customised implant) for the patient, which was then fixated and secured intra-operatively with 21 cortical screws. A maxillary denture and silicone facial prosthesis were also made to fit onto this frame. This is the first known case where additive manufacturing, via the use of rapid prototyping and 3D printing, was employed to manufacture a facial prosthesis.

Surgical applications of three-dimensional printing: a review of the current literature & how to get started

“…This concept has been extensively applied in Oral Maxillofac Surg For example, published applications include printing anatomical models of a variety of cranial and facial bones to shape titanium implants (86)(87)(88), printing a skull and orbital model for the molding of synthetic scaffolds in the correction of post-traumatic orbital deformity (89), printing a mandibular defect to design a surgical guide (90,91), and using a model of the pelvis to design a surgical guide for pelvic graft harvest (92). Beyond simply using the anatomic model to physically shape the implant, these models have also been used to engineer implant structure and analyze the stress distribution transferred to the implant (93).…”

Immediate Implant Placement and Provisionalization Following Tumor‐Resective Surgery in the Midfacial Region: A Case Series

“…1 While advancements in head and neck surgery, via the use of microvascular techniques and free tissue transfers, have enabled surgeons to reconstruct missing structures and achieve many of these goals, this is not always possible in the midfacial region. 2 Currently, no single reconstructive technique is able to achieve all these goals. Thus, a multidisciplinary approach is advocated.…”

“…These include: supporting the orbital contents; cosmetic improvement of the exenterated orbit; maintenance of a patent nasal airway with oronasal separation; provision of a stable oral platform for mastication and speech; and recreation of symmetrical contours of the reconstructed site with that of the contralateral face . While advancements in head and neck surgery, via the use of microvascular techniques and free tissue transfers, have enabled surgeons to reconstruct missing structures and achieve many of these goals, this is not always possible in the midfacial region . Currently, no single reconstructive technique is able to achieve all these goals.…”

Additive Manufacturing: A Comparative Analysis of Dimensional Accuracy and Skin Texture Reproduction of Auricular Prostheses Replicas

“…Additive manufacturing (AM) is emerging in the medical field––especially in surgery and rehabilitation . These advancements touched upon maxillofacial surgery and prosthetics during the last decade . For the rehabilitation of patients suffering from total or partial ear absence, prosthetic appliances have always been considered as a valid solution .…”

“…1 These advancements touched upon maxillofacial surgery and prosthetics during the last decade. 2,3 For the rehabilitation of patients suffering from total or partial ear absence, prosthetic appliances have always been considered as a valid solution. 4 In this field of rehabilitation, a digital workflow has been shown to be advantageous to a conventional one.…”