Surgical reconstruction of the ossicular chain with custom 3D printed ossicular prosthesis

Abstract

BackgroundConductive hearing loss due to ossicular abnormalities occurs from many causes, including trauma, infection, cholesteatoma, surgery and congenital anomalies. Surgical reconstruction of the ossicular chain is a well-established procedure for repair of ossicular defects, but is still plagued by high failure rates. Underlying disease and proper sizing of prostheses are two challenges that lead to component failure. Three-dimensional (3D) printing has been used successfully to solve a number of medical prosthesis problems. Custom 3D printing an individualized ossicular prosthesis would be a potential solution for the wide range of anatomic variation encountered in the pathological middle ear, and could decrease the rate of post-operative prosthesis displacement by increasing the likelihood of a proper fit, in addition to decreasing surgical time.In this study, the incus was removed from three formalin-fixed cadaveric human temporal bones with no macro- or microscopic evidence of pathology. Imaging of the cadaveric bone was obtained using a standard temporal bone CT protocol. A custom prosthesis for each cadaveric human temporal bone was designed using the Mimics Innovation Suite software (Materialise, Belgium) and fabricated on a Form2 3D printer (FormLabs, Somerville, Massachusetts). Four surgeons then performed insertion of each prosthesis into each middle ear, blinded to the bone from and for which each was designed. The surgeons were asked to match each prosthesis to its correct parent bone.ResultsEach prosthesis had unique measurements. Each of the four surgeons was able to correctly match the prosthesis model to its intended temporal bone. The chances of this occurring randomly are 1:1296.ConclusionsA custom 3D printed ossicular prosthesis is a viable solution for conductive hearing loss due to ossicular chain defects. Commercially available CT scanners can detect significant anatomic differences in normal human middle ear ossicles. These differences can be accurately represented with current 3D printing technology and, more significantly, surgeons can detect these differences.

Micro‐CT of the human ossicular chain: Statistical shape modeling and implications for otologic surgery

“…Recent work has aimed at developing semi-automated or fully automated segmentation algorithms to be used in these studies. Atlasbased and deep learning techniques present emerging solutions to automated segmentation (Ferreira, Tavares, & Gentil, 2012) but require a large sample size of high-fidelity models to adequately train the algorithms. To date, no such models have been publicly available.…”

“…Virtual reality surgical simulators are increasingly being used for middle ear surgery training and can incorporate patient‐specific anatomy (Locketz et al, 2017). Three‐dimensional (3D) printed ossicles are being used for educational and surgical training purposes (Cohen & Reyes, 2015; Nguyen et al, 2017; Rose et al, 2015), and are also being proposed for use as prostheses for surgical ossicular chain reconstruction (Hirsch, Vincent, & Eisenman, 2017).…”

On the adoption of additive manufacturing in healthcare: a literature review

“…Another limitation to the 3D printed prosthetics is that it can be applied only if there is no sign of chronic infection (Hirsch et al , 2017). The printed prosthetics is also limited to simple work, while the heavy load work or jobs with more wrist work cannot be performed efficiently.…”

Trimačio Spausdinimo Otorinolaringologijoje Perspektyvos

“…lėtinių vidurinės ausies ligų yra susiję su klausos kauliukų defektais, kurie lemia kondukcinį klausos sutrikimą [7]. Klausai grąžinti, esant indikacijų, galima naudoti klausos kauliukų protezus, kurie geresni už įprastus, plastiškesni, ilgaamžiai, stabilesni, individualiai sukurti kiekvienam ligos atvejui [16][17][18]. 3D spausdinimą taip pat galima panaudoti klausos reabilitacijoje.…”