scholarly journals Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and “Hybrid” Patient-Specific Implants

2020 ◽  
Vol 9 (5) ◽  
pp. 1579 ◽  
Author(s):  
Guido R. Sigron ◽  
Nathalie Rüedi ◽  
Frédérique Chammartin ◽  
Simon Meyer ◽  
Bilal Msallem ◽  
...  
Keyword(s):  
Intervention Group ◽  
Three Dimensional ◽  
Orbital Floor ◽  
Patient Specific ◽  
Titanium Mesh ◽  
Patient Specific Implants ◽  
Absolute Volume ◽  
Orbital Floor Fractures ◽  
3D Printed ◽  
Volume Difference

The aim of this study was to compare the efficacy of the intraoperative bending of titanium mesh with the efficacy of pre-contoured “hybrid” patient-specific titanium mesh for the surgical repair of isolated orbital floor fractures. In-house 3D-printed anatomical models were used as bending guides. The main outcome measures were preoperative and postoperative orbital volume and surgery time. We performed a retrospective cohort study including 22 patients who had undergone surgery between May 2016 and November 2018. The first twelve patients underwent conventional reconstruction with intraoperative free-hand bending of an orbital floor mesh plate. The subsequent ten patients received pre-contoured plates based on 3D-printed orbital models that were produced by mirroring the non-fractured orbit of the patient using a medical imaging software. We compared the preoperative and postoperative absolute volume difference (unfractured orbit, fractured orbit), the fracture area, the fracture collapse, and the effective surgery time between the two groups. In comparison to the intraoperative bending of titanium mesh, the application of preformed plates based on a 3D-printed orbital model resulted in a non-significant absolute volume difference in the intervention group (p = 0.276) and statistically significant volume difference in the conventional group (p = 0.002). Further, there was a significant reduction of the surgery time (57.3 ± 23.4 min versus 99.8 ± 28.9 min, p = 0.001). The results of this study suggest that the use of 3D-printed orbital models leads to a more accurate reconstruction and a time reduction during surgery.

scholarly journals Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models

2021 ◽  
Vol 10 (16) ◽  
pp. 3509
Author(s):  
Guido R. Sigron ◽  
Marina Barba ◽  
Frédérique Chammartin ◽  
Bilal Msallem ◽  
Britt-Isabelle Berg ◽  
...  
Keyword(s):  
Titanium Implant ◽  
Cosmetic Outcome ◽  
Orbital Floor ◽  
Surgical Reconstruction ◽  
Patient Specific ◽  
Ocular Motility ◽  
Titanium Mesh ◽  
Anatomical Models ◽  
Orbital Floor Fractures ◽  
3D Printed

The present study aimed to analyze if a preformed “hybrid” patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture’s shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called “hybrid” patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when “hybrid” patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery’s timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.

scholarly journals Accuracy Assessment of Molded, Patient-Specific Polymethylmethacrylate Craniofacial Implants Compared to Their 3D Printed Originals

2020 ◽  
Vol 9 (3) ◽  
pp. 832 ◽  
Author(s):  
Dave Chamo ◽  
Bilal Msallem ◽  
Neha Sharma ◽  
Soheila Aghlmandi ◽  
Christoph Kunz ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Accuracy Assessment ◽  
Three Dimensional ◽  
Production Costs ◽  
Patient Specific ◽  
Patient Specific Implants ◽  
3D Printed ◽  
Cost Efficient ◽  
Craniofacial Implants ◽  
Aided Design

The use of patient-specific implants (PSIs) in craniofacial surgery is often limited due to a lack of expertise and/or production costs. Therefore, a simple and cost-efficient template-based fabrication workflow has been developed to overcome these disadvantages. The aim of this study is to assess the accuracy of PSIs made from their original templates. For a representative cranial defect (CRD) and a temporo-orbital defect (TOD), ten PSIs were made from polymethylmethacrylate (PMMA) using computer-aided design (CAD) and three-dimensional (3D) printing technology. These customized implants were measured and compared with their original 3D printed templates. The implants for the CRD revealed a root mean square (RMS) value ranging from 1.128 to 0.469 mm with a median RMS (Q1 to Q3) of 0.574 (0.528 to 0.701) mm. Those for the TOD revealed an RMS value ranging from 1.079 to 0.630 mm with a median RMS (Q1 to Q3) of 0.843 (0.635 to 0.943) mm. This study demonstrates that a highly precise duplication of PSIs can be achieved using this template-molding workflow. Thus, virtually planned implants can be accurately transferred into haptic PSIs. This workflow appears to offer a sophisticated solution for craniofacial reconstruction and continues to prove itself in daily clinical practice.

scholarly journals Accuracy and Safety of In-House Surgeon-Designed Three-Dimensional Printed Patient Specific Implants for Wafer-Less Le Fort I Osteotomy

2021 ◽  
Author(s):  
Yiu Yan LEUNG ◽  
Jasper Ka Chai LEUNG ◽  
Alvin Tsz Choi LI ◽  
Nathan En Zuo TEO ◽  
Karen Pui Yan LEUNG ◽  
...  
Keyword(s):  
Orthognathic Surgery ◽  
Three Dimensional ◽  
Patient Specific ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Patient Specific Implants ◽  
Principal Axes ◽  
Operative Complications ◽  
3D Printed ◽  
Le Fort I

Abstract The design and fabrication of three-dimensional (3D) -printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy. The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included. The median linear deviations of the post-operative maxilla of the x, y and z axes were 0.74 mm, 0.75 mm and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw and roll were 1.40°, 0.90° and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period. The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe. Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery.

scholarly journals A Multi-Criteria Assessment Strategy for 3d Printed Porous Polyetheretherketone (Peek) Patient-Specific Implants for Orbital Wall Reconstruction

2021 ◽  
Author(s):  
Neha Sharma ◽  
Dennis Welker ◽  
Soheila Aghlmandi ◽  
Michaela Maintz ◽  
Hans-Florian Zeilhofer ◽  
...  
Keyword(s):  
3D Printing ◽  
Three Dimensional ◽  
Patient Specific ◽  
Fused Filament Fabrication ◽  
Decision Matrix ◽  
Maximum Deformation ◽  
Patient Specific Implants ◽  
High Durability ◽  
Orbital Wall ◽  
3D Printed

Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient's unique anatomy. Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.

scholarly journals A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction

2021 ◽  
Vol 10 (16) ◽  
pp. 3563
Author(s):  
Neha Sharma ◽  
Dennis Welker ◽  
Soheila Aghlmandi ◽  
Michaela Maintz ◽  
Hans-Florian Zeilhofer ◽  
...  
Keyword(s):  
3D Printing ◽  
Three Dimensional ◽  
Patient Specific ◽  
Fused Filament Fabrication ◽  
Decision Matrix ◽  
Maximum Deformation ◽  
Patient Specific Implants ◽  
High Durability ◽  
Orbital Wall ◽  
3D Printed

Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient’s unique anatomy. Material extrusion or Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.

Cost Analysis of Implants in the Surgical Repair of Orbital Floor Fractures

2019 ◽  
Vol 129 (5) ◽  
pp. 456-461
Author(s):  
Mark M. Mims ◽  
Eric W. Wang
Keyword(s):  
Large Scale ◽  
Tertiary Care ◽  
Hospital Charge ◽  
Cost Of Care ◽  
Orbital Floor ◽  
Patient Specific ◽  
Total Cost ◽  
Patient Specific Implants ◽  
Orbital Floor Fractures ◽  
The Cost

Objective: Options for the management of orbital floor fractures continue to evolve offering both potential advantages as well as higher costs. To date, the effect of implant choice on the cost associated with the repair of orbital floor fractures has not been studied. Methods: A retrospective review at a tertiary care, level I trauma center examining all adult, uncomplicated orbital floor fractures that underwent open reduction and internal fixation from 2013 to 2016. Patients with concurrent operative facial fractures were excluded. The main outcomes were overall cost of care from injury to last follow-up and operating room-related costs. Costs were determined using computerized records of charges as well as the hospital Charge Description Master. Kruksal-Wallis rank sum tests were used to analyze for differences between groups. Results: Twenty-eight patients fulfilled the inclusion criteria. Eight different stock, non-patient specific, implants were used for repair. The cost of individual types of implants ranged from $70.25 to $7 718.00. Total cost of care per patient across all implant types averaged $35 585.57 (range $25 586.26 to $49 985.74, P = .34). Operation-related charges accounted for the vast majority (94.4%) of the total cost of care. One complication occurred requiring operative re-positioning of the implant with an additional $13 042.41 in charges. Conclusions: In the setting of uncomplicated orbital floor fractures, surgeons should select an implant that allows them to carry out the repair in a safe, timely fashion. Additional large-scale studies would help to further delineate cost differences.

scholarly journals In-Hospital 3D Printed Scaphoid Prosthesis Using Medical-Grade Polyetheretherketone (PEEK) Biomaterial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Philipp Honigmann ◽  
Neha Sharma ◽  
Ralf Schumacher ◽  
Jasmine Rueegg ◽  
Mathias Haefeli ◽  
...  
Keyword(s):  
3D Printing ◽  
Point Of Care ◽  
Low Cost ◽  
Three Dimensional ◽  
Patient Specific ◽  
Fused Filament Fabrication ◽  
Patient Specific Implants ◽  
Surgical Guides ◽  
3D Printed ◽  
Medical Grade

Recently, three-dimensional (3D) printing has become increasingly popular in the medical sector for the production of anatomical biomodels, surgical guides, and prosthetics. With the availability of low-cost desktop 3D printers and affordable materials, the in-house or point-of-care manufacturing of biomodels and Class II medical devices has gained considerable attention in personalized medicine. Another projected development in medical 3D printing for personalized treatment is the in-house production of patient-specific implants (PSIs) for partial and total bone replacements made of medical-grade material such as polyetheretherketone (PEEK). We present the first in-hospital 3D printed scaphoid prosthesis using medical-grade PEEK with fused filament fabrication (FFF) 3D printing technology.

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