Interview with Rodrigo Salazar Gamarra on 3D Printed Facial Prostheses

Carlito Conceiçao’s 3D printed facial reconstruction (Credit: Salazar Gamarra)

Every year there are more than 550,000 cases of head and neck cancer worldwide, with over 300,000 deaths each year. Even though surgery, radiation, and chemotherapy are at the heart of standard care for this disease, it’s just not enough. Most patients suffer physical pain after tumor removal surgery but are also affected psychologically as a consequence of facial disfigurement. In 2016 Carlito Conceiçao’s face became well known around the globe after he became the first ever person to receive a 3D printed face prostheses made using a smartphone and a 3D printer. After losing his right eye and part of his cheek to a ravaging tumor, the native Brasilian fell into a deep depression and became a recluse until he met dental surgeon and 3D printing innovator Rodrigo Salazar Gamarra, who creates facial prostheses with low-cost 3D printers that are more cost-effective than the traditional thousand-dollar pieces.

Salazar Gamarra with his groundbreaking method for facial reconstruction (Credit: Salazar Gamarra)

“Unfortunately, this type of cancer has the highest rate of suicides due to the aggressive facial mutilations, affection of all five senses, as well as some of the essential functions needed to express feelings or communicate. When patients suffer consequences from cancer surgery in any other part of the body, at least it can be covered up with clothes, but the face is not easy to hide. In cases where the cancer is detected in the late stages and treatment is delayed, it can be more severe and the mutilation causes loss of essential facial traces, which means some of the patients don’t even recognize themselves in the mirror,” explained Salazar during an interview with 3DPrint.com.

This type of prosthesis existed but was far too expensive, so in 2014 Salazar and his team decided to replace some of the more expensive technology with low-cost and effective manufacturing solutions so that more people can benefit. The technique uses the camera of a common smartphone and free software, as a method for making digital facial impressions of patients with maxillofacial defects for the final purpose of 3D printing of facial prostheses (the more expensive software options are sold for 25,000 dollars a year).

The smartphone’s integrated accelerometer and a gyroscope sensor guide the operator’s 3D position during the photo capture sequence and the photos are uploaded and then converted into a virtual model of the patient’s face (Salazar has also been working with monoscopic photogrammetry to obtain 3D models via a mobile device). Then the prototype of the patient’s face is created using low-cost printers, ranging between $700 and $3,000 (versus the industrial solutions could cost around 400,000 dollars). Finally, the prosthesis is fitted with magnets that lock onto metal screws embedded in the patient. After only four months Salazar’s patients can get their custom-made prosthesis, compared with the more traditional piece that could take up to two years to make, it is definitely a life-changing solution.

Rodrigo Salazar Gamarra at work with a patient (Credit: Salazar Gamarra)

In order to find more affordable ways to develop facial prostheses, Rodrigo Salazar Gamarra, a specialist in bucomaxillofacial rehabilitation and a master’s degree in dentistry from Universidade Paulista (UNIP) where the new technique for prosthetic reconstruction of the face was created and supervised by Dr. Luciano Lauria Dib, with funds from the Brazilian government.

The procedure is being pioneered by a team of physicians in Brazil with São Paulo-based NGO Mais Identidade (known in English as Plus ID) and seeks to become a feasible low-cost alternative for clinical centers that don’t have access to high-cost technology.

According to Salazar, “the face is also one’s identity, the way for other people to recognize us,” so for patients who undergo cancer-related surgery, maxillofacial prostheses are a life-altering solution, but not everyone has access to them. The Mais Identidade Foundation hopes to promote its use in both Brazil and Peru, bringing together professionals experienced in facial disfigurement. Salazar emphasized the importance of working with patients since the initial moment of cancer-detection to make sure that the rehabilitation and reconstruction process is done in a timely manner, without any delays, and “that’s where technology gets us closer to the patient and the results we are looking for.”

“3D printing technologies help us have more predictable surgical planning, diminish operation times, reducing costs, as well as the number of interventions required. Additive manufacturing plays an extremely important role in the process of understanding what is going to be done to the patient, as well as how to facilitate the learning curve. This means that medical specialists won’t have to spend 30 years of professional practice to have this kind of experience or level of results, instead, in a short time they can acquire the ability to reproduce a procedure,” Salazar revealed. 

The expert surgeon considers that his project would benefit a lot from the regenerative tissue research being done around the globe.

“Today there already are materials that can be directly implanted in the body, but the legal certification is not the same everywhere, each country has a regulation in terms of what you can and can’t use, and that’s not perfect. Still, the speed of approval should move as fast as the speed of creation of the technology, otherwise, there is always going to be a bottleneck. In other words, government agencies must have professionals trained in this process, without any conflict of interest, so that they can make sound scientific decisions. 3D technology has the potential to change the healthcare sector, which is already happening in some countries, like the UK, where healthcare coverage for its citizens includes treatment using additive manufacturing.”

Final 3D printed prostheses (Credit: Salazar Gamarra)

In Latin America, there are positive experiences of countries willing to adopt the technology, but according to Salazar finding the right people with the know-how to develop 3D printing is no easy task.

“There is a promising opportunity for technology development in Latin America,” described Salazar. 

In 1997 the Brazilian government purchased its first 3D printer for the Renato Archer Information Technology Center (CTI), linked to the Ministry of Science, Technology, Innovations and Communications (MCTIC) of the Federal Government, and created a specialized division, the National Institute of Technology (INT), also under MCTIC, which does a lot of research using 3D printing. After 25 years of experience using AM, they have intervened in 250 hospitals and 5,500 very complex medical cases. In Peru, where Salazar is originally from, there is no Ministry of Science and Technology, like the one in Brazil, but they have recently created an entity called the CONCYTEC that provides research funds for projects involving 3D printing.

“In America’s southern region there is a gap of health professionals that should be prioritizing research and development of these technologies.”

Salazar being awarded the Innovators Under 35 Latin America 2018 from the MIT Technology Review (Credit: Salazar Gamarra)

“The research for the creation of accessible prostheses began with a team from the University of São Paulo, in collaboration with the University of Illinois in Chicago, and the Renato Archer CTI. Above all, we developed a working methodology using technologies that already existed and combining them in order to generate accessible prostheses,” described Salazar, who won the Innovators Under 35 Latin America 2018 from the MIT Technology Review in Spanish.

Renato Archer CTI’s 35 researchers explore 3D technology using FDM, Polyjet, SLA, SLS, DLP and SLM equipment, it comprises 12 technological divisions, including the three-dimensional technologies division (DT3D). Salazar understands that people who survive maxillofacial cancer face severe consequences, so his team consists of psychologists, speech therapists, engineers, plastic surgeons, neurosurgeons and rehabilitation specialists.

“This is not something that any one person can do, it requires an integrated group of people coming together to help cancer survivors,” continued Salazar.

“Our focus is on helping the patient return to society and understanding that there is a lot of suffering for them. Today we have an opportunity, to give them a better quality of life. Every day we have on average eight patients that are looking to get an affordable 3D printed prostheses, these are people who felt they were dying and came back to life because we were able to give them the face they wanted. By doing what we do and watching people overcome extreme circumstances we learn what is really important in life,” described Salazar, who hopes soon hospitals in Lima, Peru, will begin implementing this technology and methodology.

Salazar, who was also keynote speaker during the second 3D Printing Week event held during the third week of May by the Department of Industrial Engineering at the Technological Institute of Buenos Aires (ITBA), Argentina (one of the most advanced academic hubs for 3D printing in the region), hopes to institutionalize the system through Mais Identidade, setting up sustainable fundraising efforts so that more people can have access to 3D printing prostheses. 

“There are many thousands of people awaiting facial reconstruction. For healthcare physicians working with patients every day, it means a lot that a mobile device, that is within reach, can help doctors produce this type of prostheses at low costs,” suggested Salazar.