Three-dimensional printing in maxillofacial surgery: A quantum leap in future

Abstract

Although application of three-dimensional (3D) printing in oral and maxillofacial surgery (OMFS) was first reported almost 30 years back, reduction in its manufacturing cost and availability of affordable 3D printing devices have popularized its use over the past few years. The 3D-printed objects include anatomical models, occlusal splints, drilling, or cutting guides and patient-specific implants (custom made plates and reconstruction devices). The anatomical model not only assists the surgeon in better understanding of the deformity or pathology but also aids in explaining the same to the patient and relatives. Mock surgery carried out on these models improve precision and thereby reduce the operating time. The guiding splints provide an exact design and fit for the graft, thus replicating form and function of the jawbone. The patient specific implants manufactured through computer-assisted designing help in superior replication of original anatomical form. This paper intends to highlight the current applications of 3D printing in field of maxillofacial surgery in the management of facial deformity, esthetic disturbances, and jaw pathologies. Cases of condylar hyperplasia, jaw tumor, facial asymmetry secondary to joint deformity, apertognathia, and chin augmentation managed with the application of 3D printing have been described in this paper. It also discusses the history, techniques, advantages, limitations, and future scope of 3D printing technology in OMFS.

Keywords: Computer-aided designing; computer-aided manufacturing; jaw deformity; orthognathic surgery; three-dimensional model.

Figure 1

Preoperative photograph showing facial asymmetry with chin deviation (a), Computed tomography scan of deformed mandible (b and c), Three-dimensional printed anatomical model used for patient education, preoperative assessment, and mock surgery (d), Intraoperative steps involving high condylar shave (e), Lefort I osteotomy with right maxillary impaction (f), and sagittal split ramus osteotomy with differential mandibular setback (g and h), Postoperative photograph showing facial symmetry with correction of chin deviation (i)

Figure 2

Photographs showing; swelling over chin (a), intraoral view of swelling obliterating the lingual vestibule (b), OPG showing osteolytic lesion (c), OPG taken 2 weeks after intralesional steroid therapy showing increase in the size of the lesion (arrow head) (d), software generated three-dimensional anatomical model with cutting guides (e), software designed shaping of fibula (f), cutting guide for fibula (g), intraoperative use of the surgical guide (h), excised lesion (i), three-dimensional model to shape fibula to match the neo-mandible (j) and fibula graft fixed using pre-adapted manipulates (k)

Figure 3

Postoperative clinical photograph (a) and OPG (b) showing acceptable facial contour and fibula in situ with no evidence of recurrence

Figure 4

Photographs showing; gross facial asymmetry (a), three-dimensional computed tomography image of mandible (b), coronal section of computed tomography normal right (c) and deformed mushroom shaped left mandibular condyle head with reduced joint space (d), three-dimensional printed study model (e), surgical steps Lefort 1 with down fracture of maxilla (f), SSRO of mandible (g), and postoperative view showing correction of facial deformity (h)

Figure 5

Photographs showing; severely incompetent lips with increased lower facial height (a), anterior open bite (b), lateral cephalogram to study the skeletal discrepancy (c), virtual surgical planning and placement of computer guided osteotomy cuts (d), intraoperative steps showing Lefort 1 osteotomy (e), osteotomy cuts for SSRO (f), fixation of maxilla segment using preadapted plates (g) and postoperative photograph with correction of the deformity (h)

Figure 6

Computer-guided lateral augmentation of left symphysis (a) with overlying soft-tissue envelop (b), Patient-specific implant made from three-dimensional printing of PEEK (c) used for skeletal augmentation in parasymphysis region (d)