Three-Dimensional Printing in Cleft Care: A Systematic Review

Abstract

Objective: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications. Design: Retrospective systematic review. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate. Main Outcome Measures: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes. Results: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles. Conclusion: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

A Meta-Review about Medical 3D Printing

“…Concerning the manufacturing cost a range from 0.73 $ to 4043 $ was found [78,89]. The model cost range from 11.43 $ -5500 $ [48,94]. Concerning time the operation time was reduced by [24,79] 5.7-120 minutes and the manufacturing time was 0.20 h -5 days [68,78].…”

“…Yang and colleagues [87] mentioned the following pediatric surgical sub-specialties: neurosurgery, cardiothoracic Surgery, plastic Surgery, cardiovascular surgery, urological surgery, orthopedics, ENT surgery, oncological surgery and vascular surgery. Further medical fields include plastic surgery [93,94], traumatology [95][96][97], urology [98][99][100][101][102] and vascular surgery [103][104][105][106]. The affected organs or organ systems include the aorta [13,103,106], bladder [29], brain [35,37,39], cranium [30, 31, 34, 36, 44, 48-50, 53-55, 82, 84, 86, 91], ear [48, 78-81, 83, 93], female internal genitals [46], heart [2-12, 87, 88, 104], jaw [17, 20, 21, 23, 25, 47-52, 55, 56], kidney [29,41,98,[100][101][102], lip [94], liver [19,22,28], musculoskeletal system [20, 21, 24, 31-33, 38, 43, 57-77, 89, 90, 92, 93, 95-97], prostate [98,99], rectum and colon [14,40,42,45], spine…”

“…Another author mentions transnasal sphenoid endoscopy, cerebrovascular, spinal functional surgery [38]. Oral and maxillofacial surgical procedures and plastic surgery procedures [47,48,[50][51][52][53][54][55][56]94] include orbital reconstruction surgery [48,53,54], jaw reconstruction [56] and cleft care [94]. Jacobs and colleagues [48] mention methods such as cranial defect repair, condylar head reconstruction and mandible fracture repair.…”

“…Yang and colleagues [87] mentioned the following pediatric surgical sub-specialties: neurosurgery, cardiothoracic Surgery, plastic Surgery, cardiovascular surgery, urological surgery, orthopedics, ENT surgery, oncological surgery and vascular surgery. Further medical fields include plastic surgery [93, 94], traumatology [95–97], urology [98–102] and vascular surgery [103–106].…”

Using Simulation to Develop and Test a Modified Cardiopulmonary Resuscitation Technique for a Child With Severe Scoliosis

“…Simulation as a consultative service has been promoted with the focus on consultation for systems evaluation to discover latent safety threats or the development of simulation-based education interventions. 3 Using simulation for patient-specific purposes, such as surgical planning, has also been well reported using either physically printed models [4][5][6][7][8][9][10] or virtual models. [11][12][13] Development of custom patient-specific therapeutic devices has also been well documented.…”