AMS Spring 2023

3D Printing Changing the Face of Full Facial Transplant Surgeries

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brighamUse your head. It’s a phrase we’ve heard all our lives — and often good advice. Now, scientists are taking this advice quite literally, in 3D printing models of patients’ heads to assist in facial transplants.

Patients requiring facial transplants all have one thing in common: they have been through extreme trauma with examples such as dog, bear, and chimpanzee maulings; shooting and construction accidents; and fires.

A relatively new surgical procedure that takes as long as 24 hours to complete, only a handful of full facial transplants have been done in the US, with a scattering of them done internationally as well. The first partial facial transplant was completed in 2005 in France, and the surgeries have progressed since then with a number of full — and successful — facial transplants, with one of the most famous in the US being that of the first full face transplant on Dallas Wiens in 2011 at Brigham and Women’s Hospital in Boston.

Dallas Wiens facial transplant

Dallas Wiens’ facial transplant results

It’s hard to imagine we are capable of a surgery so intricate, removing what’s left of the face and then replacing it with a new one from a donor. While there are a host of issues to consider, mainly in having to suppress the patient’s immune system and fight infection, most of these surgeries worldwide have been successful.

The process is refined with each surgery, though, and with 3D printing technology, surgeons and medical professionals now save time before and during the procedure. They are able to use 3D printed full-size models of the patients’ heads as guides to help with a variety of different issues and concerns during pre-operative planning, as well as ‘onsite’ help during the actual procedure.

Today in Chicago at the annual meeting of the Radiological Society of North America (RSNA) researchers led by Frank J. Rybicki, M.D., radiologist and director of Brigham and Women’s Hospital’s Applied Imaging Science Laboratory, Bohdan Pomahac, M.D., lead face transplantation surgeon, and Amir Imanzadeh, M.D., research fellow, presented a study regarding the use of 3D printed models of transplant recipient’s heads for pre-operative planning.

“This is a complex surgery and its success is dependent on surgical planning,” Dr. Rybicki said. “Our study demonstrated that if you use this model and hold the skull in your hand, there is no better way to plan the procedure.”

The researchers tested the impact of the 3D printed models during planning of surgery on facial transplant recipients. They used CT images of the patients’ heads to create specialized software data for 3D printing of models to assist in the Front view 3D printed modelplanning and even operative stages of a delicate surgery that involves replacing and making new vascular connections from the donor, which includes stopping flow of blood for up to an hour.

“In some patients, we need to modify the recipient’s facial bones prior to transplantation,” Dr. Imanzadeh said. “The 3D printed model helps us to prepare the facial structures so when the actual transplantation occurs, the surgery goes more smoothly.”

In general life, planning can be everything, so one can only imagine how crucial the pre-operative planning process is in attaching a new face from a donor to the transplant recipient.

“If there are absent or missing bony structures needed for reconstruction, we can make modifications based on the 3D printed model prior to the actual transplantation, instead of taking the time to do alterations during ischemia time,” Dr. Rybicki said. “The 3-D model is important for making the transplant cosmetically appealing.”

Surgeons and radiologists are all in agreement that the 3D printed models afford excellent data for them to study before the procedure occurs, as well as being able to highlight ‘complex anatomy and bony defects’ better, which can be dealt with and discussed before the procedure — rather than during.

“Less time spent in the operating room is better for overall patient outcomes,” Dr. Pomahac added.

3D printed models have been such a success in use for the transplant procedures that medical professionals will be using them for other complex procedures as well. Use of the 3D printed models for surgical planning for face transplantation procedures at Brigham and Women’s Hospital is now mandatory.

Has your doctor used a 3D printed model to explain a medical procedure to you, or used it in planning a medical procedure for you? How do you think this technology will transform medical procedures? Tell us about it in the 3D Printing and Full Facial Transplants forum at 3DPB.com.

Co-authors on the study presented are Maximilian Kueckelhaus, M.D., Kanako K. Kumamaru, M.D., Ph.D., Nicole Wake, M.S., Dimitris Mitsouras, Ph.D., Elizabeth George, M.D., Gerald T. Grant, D.M.D., M.S., Peter C. Liacouras, Ph.D., and Edward J. Caterson, M.D., Ph.D.

3DPrintedFacialModel1

3D printed facial model

3D printing was not used for this woman's surgery.  Examaple only. Image: Cleveland Clinic

3D printing was not used for this woman’s surgery. Example only. Image: Cleveland Clinic

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