The convergence of three-dimensional (3D) simulation, tissue engineering, and 3D printing technology is creating a paradigm shift in plastic surgery. In augmentation rhinoplasty, determining the ideal material and design method has been a critical issue for many years. Thus, these technologies are expected to make important contributions to augmentation rhinoplasty.
We sought to validate the feasibility of the 3D carving simulation and patient-specific implant fabrication system (3D carving system) in a clinical trial using reproducibility tests.
Patient-specific implants were designed using a program developed in-house with preoperative computed tomography (CT). Negative molds of the implant were fabricated by a 3D printer and silicone was injected into these molds (Fig 1-2). To check the exact planned implant position during surgery, the distance from the line connecting the right and left medial canthus to the most cephalic point of the implant was measured (Fig 3-4). Ten actual silicone implants were fabricated and compared with virtually designed implants. Seven patients underwent surgery and postoperative CT to confirm implant positioning.
Virtually designed implants were produced into actual implants within 0.07 mm with a 0.17% ± 0.11% difference. The percentage within the gap was the highest at the cephalic end of the implant and reduced from the cephalic to caudal end (most cephalic point: 100%; rightmost and leftmost point of the implant at the caudal end of the nasal bone: 57.1% and 71.4%, respectively; rightmost and leftmost point at the supratip break: 28.6% and 28.6%, respectively; and most caudal point: 0%) (Fig 5-6). During postoperative period of 2 months, patients were fully satisfied with the result of the operation without any complications. On CT scans the ventral surface of the implant is accurately contoured so that it fits nicely with the patient’s nasal bone (Fig 7).
The 3D carving system can facilitate rhinoplasty by enabling the more intuitive, rapid, and accurate fabrication of implants irrespective of surgeon experience level.
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