Craniofacial Reconstruction by a Cost-Efficient Template-Based Process Using 3D Printing

Abstract

Craniofacial defects often result in aesthetic and functional deficits, which affect the patient's psyche and wellbeing. Patient-specific implants remain the optimal solution, but their use is limited or impractical due to their high costs. This article describes a fast and cost-efficient workflow of in-house manufactured patient-specific implants for craniofacial reconstruction and cranioplasty. As a proof of concept, we present a case of reconstruction of a craniofacial defect with involvement of the supraorbital rim. The following hybrid manufacturing process combines additive manufacturing with silicone molding and an intraoperative, manual fabrication process. A computer-aided design template is 3D printed from thermoplastics by a fused deposition modeling 3D printer and then silicone molded manually. After sterilization of the patient-specific mold, it is used intraoperatively to produce an implant from polymethylmethacrylate. Due to the combination of these 2 straightforward processes, the procedure can be kept very simple, and no advanced equipment is needed, resulting in minimal financial expenses. The whole fabrication of the mold is performed within approximately 2 hours depending on the template's size and volume. This reliable technique is easy to adopt and suitable for every health facility, especially those with limited financial resources in less privileged countries, enabling many more patients to profit from patient-specific treatment.

Fig. 1.

Model of the forehead (white) and implant template (black).

Fig. 2.

Silicone mold and implant template.

Fig. 3.

Compression molding technique.

Fig. 4.

Patient-specific implant made from PALACOS R+G.

Fig. 5.

Preoperative planning (A), implant design (B), compression molding technique (C), intraoperative result (D).

Fig. 6.

Preoperatively planned, patient-specific implant (left side) and manually shaped implant (right side).