In the Health Design Lab, there are always several projects going on at once. Whether it’s the smarterPLAY project looking at how community members use playgrounds and public space, or rehearsal of design thinking workshops, there’s constantly something interesting happening. One project that’s currently moving at a lightning fast pace is our Ear, Nose, and Throat (ENT) 3D Printing Project. This project focuses on a surgery called mandibular reconstruction, during which a part of the mandible is removed, leaving a gap in the bone that has to be supported by a metal plate and transplanted bone. This plate must be manually bent and re-bent so it fits into the patient's jaw just right -- this process can take up to 45 minutes and is standard of care for this type of reconstructive surgery.
One of the great parts about having the Health Design Lab at the hospital is that a lot of inspiration comes from our clinicians when they pop in to check it out. This project started when a group of our ENT Surgeons came in, saw our 3D printers, and immediately had a number of ideas for utilizing them. One of these ideas was using our in house Ultimaker and FormLabs 3D printing capabilities to print models to plan mandibular reconstruction surgery.
By 3D printing a custom model jaw from a patient's CT scan, it can be used as a reference and guide for surgeons to pre-bend plates prior to surgery. These metal plates would then be sterilized, taken into the operating room, and used to reconstruct the patient's jaw. If changes or alterations needed to be made because the fit wasn’t just right, these adjustments could happen in real time during the surgery. We thought by pre-bending the plates, we could hopefully decrease the time in the operating room used to adjust or bend the plates, and therefore also decrease time of wound and anesthesia exposure to the patient. These models could be a useful reference tool for surgeons before the operation as a way to visualize the patient’s anatomy and the potential complications that may occur.
After figuring out a completely open source workflow consisting of three software programs (3DSlicer, Meshmixer, and Cura), we were able to start printing patient mandibles. So far we have printed three patient mandibles, of which two have been used to pre-bend plates on and then later taken into the OR. One of those mandible models was printed not only using PLA (a biopolymer similar to plastic), but also using medical resin that can be sterilized and taken into the operating room. Of the two models that were used to pre-bend plates, both were deemed accurate, considering only minor adjustments had to be made to the plates once in surgery. So overall, the models so far seem to be true to the real patient mandibles and helpful both in the OR and during surgical planning.
Another way these 3D printed models could be used is in a training program for residents learning how to pre-bend plates. Because bending plates is something that’s not routinely taught in medical school, we thought to ourselves, ‘What if we printed a bunch of these models and just had residents bend plates on them?’ Along the same lines, the team also came up with the idea about using the same models that the plates were bent on for patient education purposes. We wanted to find out how a patient would feel if they had their own mandible printed out and able to hold in front of them -- how would this affect their care experience? Would they understand their surgery better? How would this change perspectives on patient-physician interaction?
From this (relatively) simple idea of 3D printing patient mandibles have come a whole slew of related project ideas, papers, and articles. It’s almost hard to keep up with all the ideas our team is coming up with. So far, only the pre-bending of mandibular plates on models has gone into affect, however the team is still moving forward, and at a fast pace, with perfecting the workflow, writing papers, printing more models, and putting these other project ideas into actions.