In describing one of their most recent, complex, and successful case studies, the 3D Systems team uses the word ‘choreography.’ This perfectly defines how planning was made between medical professionals and 3D Systems, putting the people—and the futuristic 3D tools in place–to further repair major deformities to eight-year-old Grace Kabelenga’s face, all caused by the encephalocele she was born with.
Grace’s story is one that has been imprinted in my mind since we began following her medical journey, one full of surgeries and miracles thanks to technology. What she must have endured prior to receiving initial help by the World Craniofacial Foundation (WCF)–and its founder and chair Dr. Kenneth Salyer–is unimaginable, and most of us can’t even know the pain, social stigma, and darkness she felt—all at such an early age. What we do know is that she has been far braver by far than most have to be as well, and her family, doctors and experts at 3D Systems have gone more than the extra mile (and literally!) for one little girl from Ndola, Zambia, offering a glimpse into what humanity and technology can achieve together.
For her entire life, Grace has been challenged with a craniofacial abnormality, only made worse after serious infection, resulting in doctors having to remove an alarming amount of skull. Once the infection was under control, they had to find a way to re-form her forehead. In her initial surgery for this, 3D systems began with the medical team by giving them access to Virtual Surgical Planning (VSP). This allows for a complete 3D and virtual reality simulation of an upcoming surgery, made possible by using data from the patient’s CT scans.
“The information that was provided by 3D Systems enabled virtual planning over the Internet by participants in various locations around the world,” says Dr. Salyer of WCF.
At this point, they also 3D printed guides, models, and templates that were patient-specific to Grace, allowing for surgeons to navigate through the surgery. All of this was made possible on both the 3D Systems ProX 800 and ProJet 7000 stereolithography (SLA) printers, allowing for the surface smoothness and definition they required. The ProJet 7000 HD is meant for dental applications, further enabling them with this particular surgery, performed in Mexico City.
Surgeons were able to continue working on the initial encephalocele, where brain was exposed in the back of her mouth—as well as even actually moving her eyes so that they would be closer together.
“We were able to move the pieces of the entire anatomical puzzle into precise position only because of the guides created by 3D Systems from the 3D models,” says Dr. Salyer. “Without them, the precision required would be impossible.”
Once that surgery was completed, they knew there was much more work to do in regards to her forehead area. 3D Systems guided surgeons in using 3D printing technology to create history with the first 3D printed forehead implant, including a lattice that would slowly allow bone to grow around it with the 3D printed piece safely biodegrading.
Plans for this surgery emanated from Denver, Colorado at the 3DS Healthcare Technology Center. Again, the team used VSP and 3D printing, working with surgeons and other necessary team players from all over the world:
- Dr. Salyer in Dallas, Texas
- Dr. Bruce in Washington, D.C.
- Plastic surgeon Dr. Frank R. Graewe and his clinical team in Cape Town, South Africa
- Medical device company KLS Martin in Jacksonville, Florida, and Tuttlingen, Germany
- Bacterin, an accredited tissue bank and medical device company based in Belgrade, Montana
This successful surgery was performed in Cape Town, South Africa at the Tygerberg Hospital in May 2015. It hinged on all of the choreography coming together, in combination with all of the 3D tools and 3D printed models. The 3DS team was able to help in the fabrication of a new forehead for Grace by using their 3D sculpting software, Geomagic Freeform Plus. According to 3D Systems, this is what allowed them to make the complex, organic curves for the forehead. The accompanying 3D haptic device and software combined meant that the team could make edits to their work digitally, and conveniently.
When they were all satisfied with the design, KLS Martin 3D printed the final implant, as well as also allowing for the initial design of a patient-specific bone graft to be ultimately created by Bacterin.
“Planning the surgery for Grace was particularly demanding,” says Shawn Burke, director of product development for KLS Martin North America. “Unlike many cases, Grace was missing a large volume of bone, making it a challenge to create a reconstruction that is strong enough but goes away and allows for the patient’s own bone to grow. The other challenge was the six teams from three continents that had to be able to see and interact with the 3D simulations in real-time. This was truly a multinational effort and solution coordinated by 3D Systems.”
Bacterin took the lead after the implant was 3D printed. They were given, according to 3DS, fabricated molds for a personalized ‘bandeau.’ This is that piece of bone right over the eyes which outlines the superior orbital rims. Bacterin’s 3Demin material was used to shape this area, along with using 3Demin sheets, OsteoSponge, and OsteoWrap allografts in the amazing reconstruction for Grace’s forehead and face.
“The manufacturing process for the customized 3Demin allografts required that the molds be sterilizable and specific to the processing requirements for Bacterin’s 3Demin Fiber Technology,” says Mike Rensberger, head of 3D Systems’ VSP Reconstruction services.
“Using the same SLA technology and resin that we used to produce the models and templates for Dr. Salyer’s reference, we were able to produce these highly precise, case-specific, custom-made parts much more rapidly than could be achieved using traditional techniques such as machining or injection molding.”
With perfect choreography indeed, and success as Grace’s body accepted the implant and the bone began growing back, now the opportunity is there for another surgery this year that will allow doctors to reconstruct the soft tissues area such as:
- The nose
- Nasal passages
- Upper lip
- Eye areas
The team from 3D Systems points out that Dr. Salyer has written a book, and there, he sums up his work here as well.
“Early in my life, I found my calling and committed myself to a life that would matter—to spending the years allotted to me giving children faces that would allow them to shape lives of their own that would matter as well,” says Dr. Salyer in his autobiography, A Life that Matters.
While the surgery, the success, and Grace’s continued journey are all incredibly inspirational, the impressive coordination required from team members completely on board from all around the world is certainly something to consider—just one more ingredient of the entire story that—along with 3D printing—would not have been possible in the recent past. Have you been following Grace’s inspiring story? Discuss in the 3D Printed Implant for Grace forum over at 3DPB.com.[Source: 3D Systems / All Images courtesy of 3D Systems]