Precision Rhinoplasty Using Virtual Surgical Planning and Departmentally-Manufactured, 3D-Printed, Sterilizable, Patient-Specific Anatomic Models

Goals/Purpose:

Rhinoplasty relies on clear patient communication and precise execution of a three-dimensional (3D) plan to achieve optimal results.¹ 3D printing is becoming more popularized in the medical field as an aid to technical planning, patient communication, and the performance of this challenging operation.^2,3 The current price of an individual set of commercial 3D-printed guides or models may reach upwards of several thousand dollars and is often prohibitive to the patient. We have developed an affordable, reproducible protocol for rapid in-house virtual surgical planning and subsequent manufacture of 3D-printed rhinoplasty models using departmentally available resources.

 

Methods/Techniques:

3D digital photographic images (3dMD, Atlanta, GA) of a patient’s face are taken and converted to sterolithography (.stl) files. The images are uploaded to a freely available 3D imaging platform, Blender^TM (Version 2.78, Amsterdam, The Netherlands). Utilizing functions available within Blender, we perform virtual rhinoplasty for each patient including: lowering the dorsum, straightening the upper and middle vault, infracture, medialization of the alar base, columellar lengthening/straightening, superior rotation of the depressed lower lateral cartilage, tip refinement, and alteration of nasal tip rotation/projection. Completed surgical models are comprised of a facial moulage defined by the superior border of the eyebrows, the inferior border of the mandible and the lateral border of each orbit. The 3D reconstructions from before and after virtual surgery planning are manufactured in-house by a departmentally-owned 3D printer (Ultimaker 3+ Extended) and white polylactic acid (PLA) filament (Batch #: 15099905). Upon completion, these models are sterilized according to a low temperature protocol (121° C for 60 minutes followed by 30 minutes dry cycle) set forth by the manufacturer and brought into the operating room, where they are available to the surgeon throughout the procedure.  

 

Results/Complications:

Twelve patients have undergone rhinoplasty using virtual surgical planning and departmentally manufactured, sterilizable, patient-specific 3D printed models of preoperative and planned “postoperative” facial/nasal appearance. Four patients underwent cosmetic rhinoplasty, five underwent correction of cleft nasal deformity, and three underwent rhinoplasty to correct nasal deviation associated with trauma. Digital models were available to the surgeon preoperatively for review of treatment plan with the patient and confirmation of operative approach. Each target model required 4 hours average of digital preparation/sculpting time. Manufacturing averaged 22 hours of 3D printing time. Approximately 60 grams of PLA are used in the production of each model, and the materials cost of each pair of pre- and post-operative models was $4.00.

 

Conclusion:

We present a protocol for virtual surgical planning and in-house manufacturing of sterilizable, scaled, patient-specific, 3D printed rhinoplasty models which can be affordably reproduced within other academic centers to assist in patient education, preoperative planning, and technical execution of this procedure.

 

References:

 

1. van Heerbeek N, Ingels KJ, van Loon B, Plooij JM, Berge SJ. Three dimensional measurement of rhinoplasty results. Rhinology 2009;47:121-5.
2. Choi YD, Kim Y, Park E. Patient-Specific Augmentation Rhinoplasty Using a Three-Dimensional Simulation Program and Three-Dimensional Printing. Aesthet Surg J 2017;37:988-98.
3. Heppt WJ, Godbersen H, Hildebrandt T. An interactive three-dimensional nose model for rhinosurgery. Facial Plast Surg 2013;29:121-6.