INNOVATION
Additive manufacturing for cranioplasty
In a recent example, a patient presented with a meningioma caused by a benign growth on the left side of the cranium. The CT scan revealed that the growth was expanding into the skull. The patient required a craniotomy to remove the tumour and a cranioplasty to rebuild the skull. PDR, a design consultancy, developed a PSI cranial plate and custom guide for the craniotomy. Due to the design precision additive manufacturing offered, the implant fit the exact specification given by the surgeon, which resulted in a good aesthetic outcome with the implant matching the patient’s cranial contours. The patient was discharged in four days and was found to be complication free.
Additive manufacturing for mandibular reconstruction
A recent procedure at the University Hospital of Wales required complex reconstructive
Using additive manufacturing to produce the implant and guides resulted in the perfect fit of bone segments.
surgery. The surgeons used a digital workflow and pre-planning to optimise productivity. The patient required a mandible reconstruction due to cancer of the lower jaw, which involved the removal of the left side of the jaw. A section of bone and vascular tissue was removed from the fibula to reconstruct the sectioned jaw. For the operation to be successful, a perfect fit between the two harvested fibula sections and the two remaining healthy sections of the jaw was required. A mandibular plate was constructed to hold the sections together. The operation involved additive manufactured cutting and drilling guides, additive manufactured implants and a pre-planned surgical approach. The cutting
guides were used to harvest the best section of bone and soft tissue to prevent morbidity and establish a healthy blood supply to aid recovery.
Using additive manufacturing to produce the implant and guides resulted in the perfect fit of bone segments. The complex surgery was delivered with high precision, which aided patient safety. The pre-defined cutting and drilling guides reduced the risks that a freehand operation could present. The Renishaw Healthcare Centre of Excellence in Miskin, near Cardiff in Wales contains a facility for the manufacture of medical products under the ISO13485 quality management system. The facility is focused on the production of
craniomaxillofacial specific implants, jigs and guides. Anatomical models are manufactured to complement implant manufacturing in polycarbonate using a fusion deposition machine (FDM) machine.
3D printed models Models, guides and implants for cranial surgery
Outside of PSI production, 3D printing is used to make models for surgical preparation. This provides surgeons with a tangible, 3D model of a specific patient. The surgeon can use this model to simulate an operation – a significant improvement on the 2D information of a scan. This can be useful to surgeons because by performing a ‘dry run’ of the procedure, they can confirm the implant design is suitable, meaning that if there is any difficulty in placing the implant it can be resolved before the surgery, rather than during. 3D printed models can also be used for training and teaching, as tissue characteristics can be replicated for normal and pathological examples. This bypasses the traditional training approach and can accelerate the training pathway, giving surgeons the opportunity to practise on complex or uncommon pathologies.
Looking forward
Projects are underway to increase the uptake of additive manufactured craniomaxillofacial PSIs. These include the award winning project Additive-manufacture for Design-led Patient Treatment (ADEPT), which aims to simplify the design of CMF implants by increasing the automation in design and offering reduced costs relative to existing subscription based design software packages. 3D printing is a rapidly expanding technology that offers benefits in efficiency, accuracy and ease of customisation. These applications will extend in future, perhaps even to the 3D bioprinting of tissue and organs. Once the technology’s potentials are realised, 3D printing will become increasingly used in medical procedures.
56 I
WWW.CLINICALSERVICESJOURNAL.COM FEBRUARY 2017
CSJ
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
