Imagine you’re at the dentist’s office, having a routine cleaning and checkup, and the dental hygienist finds a tumor in your mouth. It sounds like a bad dream, but it was reality for Tommy Innes, a Newcastle United football fan and an electrician for the Royal Victoria Infirmary (RVI) in Newcastle, with the UK’s National Health Service (NHS). A lump was discovered in his lower left jaw at a typical dental checkup, and Innes was referred to the Dental Hospital at the RVI. Thankfully, maxillofacial surgeon James Adams told Innes that the tumor was benign, but that didn’t mean his troubles were over: if the tumor was allowed to develop, not only would it become painful, it could also lead to trouble swallowing and speaking, a weakened jaw, and even a fracture. But thanks to Materialise, advanced visualization, and 3D printing technology, none of those outcomes will come to light for Innes.

To remove the tumor and fix the jaw, the surgical team would need to remove the left side of Innes’s jaw, and replace it with a section of bone from his fibula; in addition, nearly all of the teeth in the lower left part of his jaw would have to be removed. This meant that Innes would need dental implants, which the fibula bone would also help provide. 

DePuy Synthes, a medical solutions subsidiary of Johnson & Johnson, develops, produces, and markets biomaterials, implants, and instruments that are used to correct and regenerate the human skeleton and its soft tissues. It specializes in orthopedic and neuro products and services, and recently acquired 3D printed implant technology from Tissue Regeneration Systems. Last summer, Materialise announced that it would distribute the division’s patient-specific, 3D printed craniomaxillofacial (CMF) implants through DePuy Synthes TRUMATCH CMF Solutions, which use Materialise 3D printing technology; these CMF solutions were used to pre-plan and perform Innes’ surgery.

Together with Adams, plastic surgeon Omar Ahmed worked with Materialise clinical engineer Charlotte Van Melkebeke to determine the exact location for the cuts in the jaw and the leg bone. To do this, the team used ProPlan CMF software; the software suite was also helpful in providing the Materialise 3D printed surgical cut guides.

We talk a lot on 3DPrint.com about the importance of 3D surgical planning, especially in terms of plastic surgery. The technology allows surgeons to get a really advanced visualization of the cranium and facial symmetry, which is helpful when planning an operation that could have very visible drawbacks if it doesn’t go well. Knowing that 3D surgical planning will help them look normal post-op also helps with a patient’s self-confidence.

The groundbreaking reconstructive CMF surgery took ten hours. First the tumor was removed from Innes’ lower jaw, and then the team used the 3D printed guides to complete the resection with accuracy. The guides were also used to match the screw holes up with the holes in the 3D printed titanium plate, which actually fixed the section of fibula onto the jaw itself.

Adams explained that one of the advantages of the 3D printed plate is that it doesn’t need to be bent, since it’s already been contoured to fit the specific patient’s anatomy; even in the hands of the most capable surgeon, it’s very difficult to bend conventionally manufactured plates. Ahmed said that the 3D visualization helped with a critical healing process for the bone, as it establishes “precise contact between the grafted section of leg bone and the jawbone.”

Typically, when a jaw reconstruction requires dental implants, it also means that the patient has to undergo a second surgical procedure. While this could be a cause of anxiety in other cases, the surgeons working with Innes could plan exactly where the dental implants needed to go in his new jawbone ahead of time. In addition, before the fibula was removed, the team was able to create a basis for replacement teeth.

“What was unique about Tommy’s operation was the use of this revolutionary technology to plan our dental implants on the leg,” said Adams. “Technology is making it quicker and easier for us to carry out these procedures accurately.”

Innes had a good bite, facial symmetry, and a healthy supply of blood to his lower jaw, all of which helped his two procedures go smoothly. While his voice, and the way he talks, may be a little different for the time being, his face luckily still looks the same. These great results may not have been possible without the use of 3D planning and the 3D printed guides from Materialise. Discuss in the Materialise forum at 3DPB.com.

[Source: Materialise / Images: BBC]

 

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