Surgeons use 3D Systems' software for complex fracture

After a patient was admitted with a complex fracture, the CraniomaxillofacialSurgery unit at Galilee Medical Center in Nahariya, Israel, headed by Prof.Samer Saruji, initiated a surgical planning workflow using 3D Systems’ surgicalplanning software.

The 22 year-old female suffered from a left orbital fractureafter falling from the second floor, and it was decided to create an implant inorder to reconstruct the missing part in her left orbit.

“Due to the complexity of the fracture and its delicatelocation, one of the challenges the team faced was to achieve optimal fittingof the implant to the patient’s anatomy while preserving its functionality andhighest aesthetic results,” said Dr. Lior Tzadok, senior craniomaxillofacial surgeon,Galilee Medical Center.

Craniomaxillofacial surgeons perform major structuralsurgeries that involve bones and soft tissues (skin and muscle) in the head andneck area. The complex anatomy of the craniofacial skeleton presents achallenge when attempting to achieve the ideal aesthetic and functionaloutcomes.

“Using D2P software, we were able to segment the replicatestructures out of the patient’s CT scan and send it for printing in our 3D lab(CJP 460 printer, 3D Systems). The printed gypsum model allowed us to betterunderstand the patient’s pathology. Using FreeForm 3D systems’ design software,we mirrored the healthy side, shaped the implant and sent the implant file to 3DSystems’ FDA and CE registered facility in Leuven, Belgium, and received aPatient Specific platinum Implant (PSI),” said Dr. Adib Zoabi, craniomaxillofacialfellow, Galilee Medical Center.

“The ability to use a few products from the same companyhelped us achieve a faster and smoother process to the end result, withoutwasting time between the workflow steps,” said Dr. Zoabi.

In addition to surgical planning, the physicians used theprinted gypsum model to verify the titanium implant fitting and explained tothe patient and family the severity of the problem and outlined the surgeryplan and the expected result.

“Since the technology enables us to accurately predict andreach the result as we planned, it is now easier for us to share the surgicalplan with the patient and his family,” said Dr. Tzadok.

This has also a positive effect on the patient’sunderstanding and trust. “The physician showed me the printed model of myhealthy and fractured orbit. I didn’t realize the magnitude of the problemuntil I saw the fracture size. I could not understand it by looking at the CT,”said the patient. “After the physician’s explanation about the procedure andseeing the implant, I felt more confident to have the surgery.”

Reconstructive surgery has historically relied on thesurgeon’s subjective assessment of form and aesthetics preoperatively andintraoperatively, with intraoperative decision-making based on visualanatomical inspection, after bending the metal plate implant. Although goodoutcomes can and are often achieved, the highly subjective nature of thisprocess results in variable surgeon-specific outcomes and can also lead toprolonged surgical time.

“The surgery was smooth and quick, and the result was beyondour expectations,” said Dr. Tzadok. “The most amazing reaction to the planningwas received in the OR. In this surgery, immediately when we put the printedplate in place according to planning, we were all looking and it was obviousthat we have the correct positioning. The eyeballs were exactly where weplanned. For surgeons, it brings something we didn’t have before, knowing themagnitude of the problem, being able to copy from the healthy side to thepathological side, and to predict the outcome. This minimizes the risk oferror, shortens the operation time and helps us know what will be the finalproduct and ‘promise it’ to our patients.”

The shortened procedure time and the excellent surgicalresult effect on the patient was obvious. “The operation was quick and almostpainless, except for a slight pain in one eye. I was released two days later.There was no scar and no one knows I had an eye operation, which is amazing.After three days, I was at home reading books,” said the patient.

Galilee Medical established a 3D printing lab in thecraniomaxillofacial unit. This is the first and currently the only center inIsrael that incorporated in-house end-to-end surgical planning workflow, inwhich physicians have the know-how for using 3D Systems’ surgical planningapplications and 3D printing.

“We are speaking in new terms in the surgical world that aredifferent from everything we used to know. More and more ‘dry runs’ areperformed before the actual surgery. The surgeon is becoming a designer,” said Prof.Saruji. “We have just started to use this workflow in our daily practice and wealready see the great progress in our patient outcome. The errors aredramatically reduced and the surgical ability of the surgeon is constantlyimproving. In addition, having those capabilities in-house helps us to reduceprocedural cost. Our success here leads to a growing interest in the hospitalto expand the 3D Lab usage to other departments, such as neurosurgery. We hopeto see this trend improving patient outcomes in more and more areas,” said Prof.Saruji.