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. 2015 Nov;136(5):e1382-5.
doi: 10.1542/peds.2015-1062. Epub 2015 Oct 5.

Antenatal Three-Dimensional Printing of Aberrant Facial Anatomy

Kyle K VanKoevering  1 , Robert J Morrison  1 , Sanjay P Prabhu  2 , Maria F Ladino Torres  3 , George B Mychaliska  4 , Marjorie C Treadwell  5 , Scott J Hollister  6 , Glenn E Green  7
Affiliations

Antenatal Three-Dimensional Printing of Aberrant Facial Anatomy

Kyle K VanKoevering et al. Pediatrics. 2015 Nov.

Abstract

Congenital airway obstruction poses a life-threatening challenge to the newborn. We present the first case of three-dimensional (3D) modeling and 3D printing of complex fetal maxillofacial anatomy after prenatal ultrasound indicated potential upper airway obstruction from a midline mass of the maxilla. Using fetal MRI and patient-specific computer-aided modeling, the craniofacial anatomy of the fetus was manufactured using a 3D printer. This model demonstrated the mass to be isolated to the upper lip and maxilla, suggesting the oral airway to be patent. The decision was made to deliver the infant without a planned ex utero intrapartum treatment procedure. The neonate was born with a protuberant cleft lip and palate deformity, without airway obstruction, as predicted by the patient-specific model. The delivery was uneventful, and the child was discharged without need for airway intervention. This case demonstrates that 3D modeling may improve prenatal evaluation of complex patient-specific fetal anatomy and facilitate the multidisciplinary approach to perinatal management of complex airway anomalies.

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Figures

FIGURE 1
FIGURE 1
Differential diagnoses: Illustrations of (A) normal neonatal maxillofacial anatomy and (B–D) differential diagnoses entertained. Epignathus (D) shows obliteration of the oral cavity and nasal airway with potential for upper airway obstruction.
FIGURE 2
FIGURE 2
Segmentation, modeling, and 3D printing of fetal MRI. (A) Representative single-shot T2 turbo spin echo-weighted MRI of the fetus reformatted in axial, sagittal, and coronal planes, which fail to clearly demonstrate the anatomy, making clinical decision-making difficult. (B) 3D model of the fetal facial soft tissues. (C) Final 3D-printed model of the fetal soft tissues demonstrating protuberant, isolated mass of the upper lip that does not involve the oral aperture. (D) Patient after successful delivery by cesarean delivery demonstrating bilateral cleft lip and palate with anteriorly displaced premaxilla.
See this image and copyright information in PMC

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