Computer Aided–Designed, 3‐Dimensionally Printed Porous Tissue Bioscaffolds for Craniofacial Soft Tissue Reconstruction

Abstract

Objectives To determine the potential of integrated image-based Computer Aided Design (CAD) and 3D printing approach to engineer scaffolds for head and neck cartilaginous reconstruction for auricular and nasal reconstruction. Study Design Proof of concept revealing novel methods for bioscaffold production with in vitro and in vivo animal data. Setting Multidisciplinary effort encompassing two academic institutions. Subjects and Methods DICOM CT images are segmented and utilized in image-based computer aided design to create porous, anatomic structures. Bioresorbable, polycaprolactone scaffolds with spherical and random porous architecture are produced using a laser-based 3D printing process. Subcutaneous in vivo implantation of auricular and nasal scaffolds was performed in a porcine model. Auricular scaffolds were seeded with chondrogenic growth factors in a hyaluronic acid/collagen hydrogel and cultured in vitro over 2 months duration. Results Auricular and nasal constructs with several microporous architectures were rapidly manufactured with high fidelity to human patient anatomy. Subcutaneous in vivo implantation of auricular and nasal scaffolds resulted in excellent appearance and complete soft tissue ingrowth. Histologic analysis of in vitro scaffolds demonstrated native appearing cartilaginous growth respecting the boundaries of the scaffold. Conclusions Integrated image-based computer-aided design (CAD) and 3D printing processes generated patient-specific nasal and auricular scaffolds that supported cartilage regeneration.

Three‐Dimensional Printing and Its Applications in Otorhinolaryngology–Head and Neck Surgery

“…As 3D-printing technology has improved, the printing time requirement has been reduced significantly. In one study, fifty auricular and nasal scaffolds were printed within four to five hours 65 . In another study, 3D-printing half a skull took just under 14 hours including preprocessing, printing, and post-17 processing 66 .…”

“…This technology could one day replace rib and calvarial bone harvesting in auricular and nasal reconstruction. 65 The biggest obstacle to organ printing is the need to elaborate a vascular network to deliver oxygen and remove waste 71 . 3D-printing allows vascular structures to be constructed from biomaterials, which can later be seeded with endothelial cells 72,73 .…”

Auricular Reconstruction from Rib to 3D Printing

“…Ideally, materials can be generated based on established biomechanical properties observed in tissues [40]. These bioscaffolds have the potential to restore craniofacial structure, with proposed patient- and tissue-specific methods previously detailed by Zopf et al that avoid the morbidity of the costal reconstruction method and the limited patient specificity of the MedPor reconstruction method [41]. …”

“…In order to address these biomechanical concerns, Zopf et al proposed using a slowly resorbing polycaprolactone (PCL) scaffold with microporous architecture designed to resist contraction in the initial phase of native extracellular matrix deposition [41]. Additionally, it demonstrated adequate shape definition upon implantation in a porcine model.…”

Co‐culture of adipose‐derived stem cells and chondrocytes on three‐dimensionally printed bioscaffolds for craniofacial cartilage engineering

“…[6][7][8][9] These techniques can be combined with patient-specific computer-aided design (CAD) and three-dimensional (3D) printing to produce high-fidelity auricular and nasal tissue engineering scaffolds. 10 However, with the many positive prospects in CTE, significant challenges remain, most notably the need for a large (10 7 ) number of cells.…”