The technique for 3D printing patient-specific models for auricular reconstruction

Flores, Roberto L.; Liss, Hannah A.; Raffaelli, Samuel D.; Humayun, Aiza; Khouri, Kimberly S.; Coelho, Paulo G.; Witek, Lukasz

doi:10.1016/j.jcms.2017.03.022

Cited by 64 publications

(53 citation statements)

References 15 publications

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“…While these tools are powerful, auricular reconstruction presents a unique challenge to reconstructive surgeons: the ear's unique and complex anatomy. A satisfactory aesthetic outcome is dependent on a surgeon's ability to accurately rebuild the anatomic subunits of the ear and place them in the correct visuospatial orientation relative to one another (Flores et al, ). Despite the plethora of tools available to create reconstructive models for these complex anatomic body parts, the current standard of care involves drawing the intended outcome in two‐dimensions, on paper.…”

Section: The Integration Of Tissue Engineering Principlesmentioning

confidence: 99%

“…In order to then refine these models and sculpt essential landmarks, open‐access software programs such as Blender TM (version 2.77, Amsterdam, The Netherlands) can digitally modify data. Using an array of selection and brush tools to isolate and refine shape, an ear model can be isolated from the rest of the cranium, “flipped” to guide the replacement of the microtia‐affected ear, uploaded to a computer aided design and manufacturing (CAD/CAM) program, and printed in three dimensions to provide (1) identical mirror images of unaffected patient ears and (2) printable subunits for surgeon convenience (Figure a–e) (Flores et al, ). Indeed our group has already reported promising early outcomes when using these 3D printed constructs (Figure ) (Flores et al, ; Witek, Khouri, Coelho, & Flores, ).…”

Section: The Integration Of Tissue Engineering Principlesmentioning

confidence: 99%

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The role of 3D printing in treating craniomaxillofacial congenital anomalies

Lopez

Witek

Torroni

et al. 2018

Birth Defects Research

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Craniomaxillofacial congenital anomalies comprise approximately one third of all congenital birth defects and include deformities such as alveolar clefts, craniosynostosis, and microtia. Current surgical treatments commonly require the use of autogenous graft material which are difficult to shape, limited in supply, associated with donor site morbidity and cannot grow with a maturing skeleton. Our group has demonstrated that 3D printed bio-ceramic scaffolds can generate vascularized bone within large, critical-sized defects (defects too large to heal spontaneously) of the craniomaxillofacial skeleton. Furthermore, these scaffolds are also able to function as a delivery vehicle for a new osteogenic agent with a well-established safety profile. The same 3D printers and imaging software platforms have been leveraged by our team to create sterilizable patient-specific intraoperative models for craniofacial reconstruction. For microtia repair, the current standard of care surgical guide is a two-dimensional drawing taken from the contralateral ear. Our laboratory has used 3D printers and open source software platforms to design personalized microtia surgical models. In this review, we report on the advancements in tissue engineering principles, digital imaging software platforms and 3D printing that have culminated in the application of this technology to repair large bone defects in skeletally immature transitional models and provide in-house manufactured, sterilizable patient-specific models for craniofacial reconstruction.

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Section: The Integration Of Tissue Engineering Principlesmentioning

confidence: 99%

Section: The Integration Of Tissue Engineering Principlesmentioning

confidence: 99%

The role of 3D printing in treating craniomaxillofacial congenital anomalies

Lopez

Witek

Torroni

et al. 2018

Birth Defects Research

Self Cite

View full text Add to dashboard Cite

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“…Several reports have introduced various methods and shapes of 3D‐printed ear models . Clinically, the previously reported 3D‐printed models are barely suitable for ear reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the numerous efforts toward tissue engineering for ear cartilage, 3D‐printed ear cartilage models have so far been used clinically only as “patient‐specific guide models” for surgical planning of ear reconstruction . Further studies are required to achieve a functional and stable tissue substitute for auricular cartilage and to extend the use of 3D‐printed ear cartilage.…”

Section: Discussionmentioning

confidence: 99%

Ideal scaffold design for total ear reconstruction using a three‐dimensional printing technique

Jung

Kim

et al. 2018

J Biomed Mater Res

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Ear reconstruction using three-dimensional (3D) printing technique has been considered as a good substitute for conventional surgery, because it can provide custom-made 3D framework. However, there are difficulties with its application in clinical use. Researchers have reported 3D scaffolds for ear cartilage regeneration, but the designs of the 3D scaffolds were not appropriate to be used in surgery. Hence, we propose the design of an ideal 3D ear scaffold for use in ear reconstruction surgery. Facial computed tomography (CT) images of the unaffected ear were extracted using a "segmentation" procedure. The selected data were converted to a 3D model and mirrored to create a model of the affected side. The design of 3D model was modified to apply to Nagata's two-stage surgery. Based on the 3D reconstructed model, a 3D scaffold was 3D printed using polycaprolactone. The 3D scaffold closely resembled the real cartilage framework used in current operations in terms of ear anatomy.To account for skin thickness, the 3D scaffold was made 4 mm smaller than the real ear. Furthermore, 2 mm pores were included to allow the implantation of diced cartilage to promote regeneration of the cartilage. 3D printing technology can overcome the limitations of previous auricular reconstruction methods. Further studies are required to achieve a functional and stable substitute for auricular cartilage and to extend the clinical use of the 3D-printed construct. Additionally, the ethical and legal issues regarding the transplantation of 3D-printed constructs and cell culture technologies using human stem cells remain to be solved. FIGURE 1. The "segmentation" procedure. The contralateral unaffected ear was extracted from other tissue using the "segmentation" procedure.

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“…Three-dimensional (3D) printing from DICOM images has become easier with advancement of technologies such as medical engineering, imaging engineering, and the evolution and decreasing costs of hardware and software. Patient-specific 3D models are now being used in many situations within the oral and maxillofacial surgery fields, including education, surgical planning, and surgical simulation [1][2][3][4].…”

mentioning

confidence: 99%

DICOM segmentation and STL creation for 3D Printing: A Process and Software Package Comparison for Osseous Anatomy

Kamio

Suzuki²,

ASAUMI³

et al. 2020

Preprint

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Background: Extracting and three-dimensional (3D) printing an organ in a region of interest in DICOM images typically calls for segmentation in support of 3D printing as a first step. The DICOM images are not exported to STL data immediately, segmentation masks are exported to STL models. After primary and secondary processing, including noise removal and hole correction, the STL data can be 3D printed. The quality of the 3D model is directly related to the quality of the STL data. This study focuses and reports on DICOM to STL segmentation performance for nine software packages.Methods: Multi-detector row CT scanning was performed on a dry human mandible with two 10-mmdiameter bearing balls as a phantom. The DICOM images file was then segmented and exported to a STL file using nine different commercial/open-source software packages. Once the STL models were created, the data (file) properties and the size and volume of each were measured and differences across the software packages were noted. Additionally, to evaluate differences between the shapes of the STL models by software package, each pair of STL models was superimposed, with observed differences between their shapes characterized as shape error.Results: The data (file) size of the STL file and the number of triangles that constitute each STL model were different across all software packages, there was no statistically significant difference were found across software packages. The created ball STL model expanded in the X-, Y-, and Z-axis directions, with the length in the Z-axis direction (body axis direction) being slightly longer than other directions. There were no significant differences in shape error across software packages for the mandible STL model. Conclusions:The different characteristics of each software package were noticeable, such as different effects in the thin cortical bone area, likely due to the partial volume effect, which may reflect differences in image binarization algorithms. Although the shape of the STL model differs slightly depending on the software, our results indicate that shape error in 3D printing for clinical use in the operation of osseous structures. BackgroundDigital Imaging and COmmunications in Medicine (DICOM) is the leading standard around the world Author informationAffiliations

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The technique for 3D printing patient-specific models for auricular reconstruction

Cited by 64 publications

References 15 publications

The role of 3D printing in treating craniomaxillofacial congenital anomalies

The role of 3D printing in treating craniomaxillofacial congenital anomalies

Ideal scaffold design for total ear reconstruction using a three‐dimensional printing technique

DICOM segmentation and STL creation for 3D Printing: A Process and Software Package Comparison for Osseous Anatomy

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