The Shape of Things to Come: In‐Hospital Three‐Dimensional Printing for Mandibular Reconstruction Using Fibula Free Flap

Abstract

Objectives/Hypothesis: The aim of this study was to explore whether the production of in-hospital, low-cost surgical cutting guides would be possible and to assess different cutting guide shapes to facilitate the surgery and the application with instruments. Study Design: Cohort study. Methods: Using free computer-aided design software, surgical cutting guides for the mandible and fibula were designed and used to perform virtual segmental osteotomies and fibula transplants in seven patients. Results: Fourteen virtual osteotomies were performed using the free software and the proposed workflow. Thirteen guides were then printed to transfer the virtual planning information to the operating room. Conclusions: Virtual planning and the three-dimensional (3D) printing of guides for mandibular reconstruction is reliable with the aid of an in-hospital 3D laboratory. We also demonstrated that different guides with different shapes could be produced with benefits during surgery.

Three-Dimensional Printing of Medical Devices Used Directly to Treat Patients: A Systematic Review

“…Among the most common were the cost and duration of patient-specific device production, especially when outsourced to specialized commercial entities. 23,28,29,39,49,62,63,72,76 The price of 3D-printed implants is estimated to be 2-to 5-times higher compared to conventional implants, 28,128,129 and additional costs include preoperative virtual planning, device design, and the production of trials or implant variations. Outsourcing is virtually inevitable for titanium implants due to their complex structure and the high cost of EBM machines.…”

“…Outsourcing is virtually inevitable for titanium implants due to their complex structure and the high cost of EBM machines. However, studies involving relatively simple devices printed in polymer-based materials also reported notably lower cost compared to conventional devices, 76,104 and successful in-house design and fabrication by medical staff. 23,76,110 Longer waiting periods for custom implantable devices may predispose patients to malignant changes, disease progression or anatomical alterations, which can complicate implantation.…”

“…However, studies involving relatively simple devices printed in polymer-based materials also reported notably lower cost compared to conventional devices, 76,104 and successful in-house design and fabrication by medical staff. 23,76,110 Longer waiting periods for custom implantable devices may predispose patients to malignant changes, disease progression or anatomical alterations, which can complicate implantation. 21,31,43 Manufacturing times would also need to improve to include acute cases 41 or contingency use.…”

Evaluation of virtual surgical planning and three‐dimensional configurations for reconstruction of maxillary defects using the fibula free flap

“…Today, however, an in‐house and self‐developed manufacturing approach for mandibular cutting guides has been developed (Bosc et al, 2017; Ganry et al, 2017). This new approach is proved to be reliable and helpful tool in reconstructive surgery (Li et al, 2018; Zavattero et al, 2020).…”

In-hospital 3D Printing to Aid Maxillofacial Surgery during the COVID-19 Pandemic

“…In 79 cases, only type 1 models were printed; in 68 cases, type 1 models were printed together with type 2 and 3 models. 2 …”