Congenital Arhinia: 3D Printed Nasal Implants for Toddlers & Adolescents Awaiting Surgery

London researchers are concerned with a rare, congenital disease known as arhinia; there are, in fact, only 60 cases reported in research. In ‘Design and Manufacturing of a Patient-Specific Nasal Implant for Congenital Arhinia: Case Report,’ the authors address a way to help patients lacking an external nose, nasal cavities, and olfactory apparatus. It is easy to understand why such an extreme condition would affect a child deeply, not only in having to deal with the physical defects but also the obvious aesthetic issues, leading to significant social anxieties.

The condition must be met with intense management in the early years to ensure the child is both able to eat and breathe, with no prosthetics designed to help thus far for shaping soft tissue—thus leading the researchers to create a 3D printed bespoke nose implant for individuals challenged with this potentially life-threatening issue.

A) 3D bone reconstruction from CT scan of the patient at age 2, front view and B) side view C) 3D printed replica of the patient skull age 2; a nose implant was moulded with plasticine by an expert craniofacial surgeon; D) 3D scan of the skull with nose implant superimposed on the patient skull; E) the nose implant volume separated from the skull and ready for manufacturing; F) the second nose implant for the second procedure.

The authors state that while there is corrective surgery, it consists of both surgical and nasal reconstruction:

“The choice of functional versus aesthetic-only reconstruction is based on presence of sinuses and the complexity of the underlying bony hypoplasia,” stated the researchers. “In practice, it is rarely possible to create a functional nasal airway and reconstruction generally focuses on producing a balanced appearance.”

Surgery usually must wait until female patients are 20 years old, and males are 22. This study has obvious, significant merit as it explores the potential of creating implants for young children, with more ‘definitive reconstruction’ available to adolescents. To begin, they created an implant for a toddler, but the implantation required two stages, beginning at age two and then again at age four. The researchers stated that the procedure was ‘successful’ and the implant was ‘well-tolerated.’ In the second phase, however, the patient did end up experiencing infection—repeatedly, due to the implant. It had to be removed until the infection dissipated, and then they continued.

A) 3D reconstruction of the patient soft tissues at age 2 (top) and age 4 (bottom); B) post-op on-table 3D scan superimposed on the 3D reconstruction at age 2 (top) and age 4 (bottom); C) sagittal cross section of the patient skull showing the soft tissue (green line), the on-table 3D scan (red line) and the implant (blue) at age 2 (top) and age 4 (bottom).

The research team was able to see ‘the full potential of 3D printing’ realized, and especially in patient-specific form. They used a range of medical models for planning the surgery, as well as for the design of the implants, and educating patients and their families about what was going on. Ultimately, the patient received an implant that fit precisely—and allows youngsters a way to avoid some of the possible psychological damage as they wait for more effective reconstruction.

“It was noticed during the second surgery (but it was also visible from the second set of CT scans) that the presence of the first implant caused the mid-face bone to grow around it,” stated the researchers. “Although this posed some challenges to the implant removal, it caused no problems to the creation and implantation of the second implant, which was designed according to the shape of the underlying newly formed bone.”

Surgical implants have been aided enormously by 3D printing and bioprinting, with progress continuing at rapid speed, from customized bone implants to mandibular implants to titanium hip implants. What do you think of this news? Let us know your thoughts! Join the discussion of this and other 3D printing topics at 3DPrintBoard.com.

A) Pre-op on-table 3D scan of the patient before the first procedure: frontal (top) and lateral (bottom) view; B) Post-op on-table 3D scan of the patient after the first procedure: frontal (top) and lateral (bottom) view C) Pre-op 3D picture of the patient before the second procedure: frontal (top) and lateral (bottom) view; D) Post-op on-table 3D scan of the patient after the second procedure: frontal (top) and lateral (bottom) view; E) Follow up 3D picture of the patient at 2 months after the second procedure: frontal (top) and lateral (bottom) view; F) surface difference between pre-op and post-op 3D scans at the first procedure; E) surface difference between pre-op and post-op 3D scans at the second procedure.

A) Picture of the patient looking at the implant prototype before the first procedure aged 2; B) picture of the patient three months after the procedure aged 2; C) picture of the patient two months after the second procedure aged 4.