(L-469) An Optimized Patient Care Approach for Craniofacial Reconstructive Surgeries by Utilizing a Low-Cost, In-House, and Point-of-Care 3D Printing and Modeling Workflow

Introduction:: Craniofacial and laryngeal reconstructive surgeries utilizing osteocutaneous free tissue transfer pose a significant anatomic challenge in restoring function and aesthetics after tumor resection or trauma. 3D-printed models of the patient’s bony or cartilage anatomy are manufactured from preoperative CT scans before surgery. The models act as objective references for reconstruction by providing a template, allowing the pre-bending of reconstructive plates, guiding the placement of osteotomies, and allowing the preoperative plan to be translated intraoperatively with high fidelity. This advantage increases the surgical precision of the resection and reconstruction.



Craniofacial surgical model requests were traditionally outsourced to third-party companies, which often cannot meet short time constraints and manufacture models. Such examples are larynx models for uncommon surgeries such as laryngeal reconstruction or unique patient-specific scenarios. An in-house 3D-printing workflow manufactures medical models with short time constraints and versatility to optimize patient care for neoplasm cases before tumor growth can render a surgical plan unusable, urgent trauma cases, uncommon surgical cases, and unique patient-specific scenarios.


Materials and Methods:: The Hospital General Council approved the FDA-validated process of patient-specific modeling. Digital Imaging and Communications in Medicine (DICOM) images from preoperative CT scans are used to isolate the desired bone — scapula, mandible, maxilla, skull, or larynx — in the medical image segmentation and 3D modeling software Materialise Mimics. Isolated images are segmented into a 3D model and imported into the 3D modeling software Materialise 3Matic where it is smoothed, repaired, and labeled for printing. The model is printed on a Formlabs Form 3B printer with Surgical Guide resin, a Class I biocompatible resin, and post-processed following the published Instructions for Use (IFU). Models are then autoclave sterilized and used intraoperatively to guide the craniofacial reconstructive surgeries.


Results, Conclusions, and Discussions:: Over 4 years, 271 models have been made for 183 patients offering cost savings to the University of Michigan Hospital of approximately $675,000. In-house 3D printing offers distinct advantages over outsourcing to commercial vendors, including faster turnaround times and the adaptability to uncommon surgical cases and unique patient-specific scenarios. Generally, model requests are completed within 2-3 days but can be completed more quickly, given short time constraints in cases with patient neoplasms or urgent trauma cases. Skull and larynx models for uncommon reconstructive surgeries and patient mandible models with preexisting reconstructive plates from prior surgeries have been manufactured utilizing this workflow. The extensive adaptability of this workflow for uncommon reconstructive surgeries increases the accessibility to craniofacial medical models suggesting an optimization of patient care for craniofacial reconstructive surgeries.



The University of Michigan College of Engineering and University of Michigan Department of Otolaryngology - Head and Neck Surgery have developed an in-house 3D modeling workflow as a collaborative process. The workflow facilitates the rapid manufacturing of patient-specific models to guide the intraoperative reconstruction of complex craniofacial defects. Developing an in-house system has several unique advantages over commercial vendors, including turnaround times, accessibility, and cost savings.


Acknowledgements (Optional): :

References (Optional): :