Office-Based Three-Dimensional Printing Workflow for Craniomaxillofacial Fracture Repair

Abstract

Three-dimensional printing of patient-specific models is being used in various aspects of craniomaxillofacial reconstruction. Printing is typically outsourced to off-site vendors, with the main disadvantages being increased costs and time for production. Office-based 3-dimensional printing has been proposed as a means to reduce costs and delays, but remains largely underused because of the perception among surgeons that it is futuristic, highly technical, and prohibitively expensive. The goal of this report is to demonstrate the feasibility and ease of incorporating in-office 3-dimensional printing into the standard workflow for facial fracture repair.Patients with complex mandible fractures requiring open repair were identified. Open-source software was used to create virtual 3-dimensional skeletal models of the, initial injury pattern, and then the ideally reduced fractures based on preoperative computed tomography (CT) scan images. The virtual 3-dimensional skeletal models were then printed in our office using a commercially available 3-dimensional printer and bioplastic filament. The 3-dimensional skeletal models were used as templates to bend and shape titanium plates that were subsequently used for intraoperative fixation.Average print time was 6 hours. Excluding the 1-time cost of the 3-dimensional printer of $2500, roughly the cost of a single commercially produced model, the average material cost to print 1 model mandible was $4.30. Postoperative CT imaging demonstrated precise, predicted reduction in all patients.Office-based 3-dimensional printing of skeletal models can be routinely used in repair of facial fractures in an efficient and cost-effective manner.

Mandibular Fractures: Diagnosis and Management

“…65 The ability of 3D planning has the potential to not only reduce OR time and costs, but also aid in educating trainees in understanding the principles of fracture management. [66][67][68][69][70] King et al showed that the use of 3D printers for fabrication of models to prebend plates drastically reduced operating time and costs (►Fig. 15).…”

Point-of-care three-dimensional printing for craniomaxillofacial trauma

“…That is, a mirror image of a non-injured facial skeleton serves as an excellent template to build upon. It was not until recently, however, that studies started to emerge demonstrating the use of CAD/CAM principles with custom milled and/or pre-bent plates for mandibular or complex facial trauma [14,[20][21][22][23][24] . Currently, these investigations generally follow two distinct paths.…”

In-House Digital Workflow for the Management of Acute Mandible Fractures

“…Several studies have described a less expensive alternative using on-site commercially available 3-dimensional (3D) printers. 10,11 This method requires the fabrication of 3-dimensionally printed models from in-office printers and either preoperative 11 or intraoperative 10 plate bending. A study showed that preoperative plate bending has the added benefit of decreasing OR time and consequently costs 11 ; however, this study required manual post-fabrication manipulation to anatomically reduce the fracture.…”

“…A study showed that preoperative plate bending has the added benefit of decreasing OR time and consequently costs 11 ; however, this study required manual post-fabrication manipulation to anatomically reduce the fracture. Elegbede et al 10 described an in-office method to virtually reduce simple mandible fractures based on mirror imaging of the contralateral side but contouring of the reconstruction plate to the model was performed intraoperatively, negating the cost savings of preoperative plate adaptation. It is important to note that 3D Slicer was used in this study, which is currently not approved by the US Food and Drug Administration (FDA) for patient use in the United States.…”