Custom nasal obturator for velopharyngeal dysfunction: Digitizing the fabrication process.

Nasal obturation using a removable medical device is a suitable treatment option for patients with velopharyngeal dysfunction. In the United Kingdom in recent years, the use of nasal obturation has increased because of the successful collaborations among the Speech and Language Therapy, Restorative Dentistry, and Maxillofacial departments. However, fabrication of the devices requires specialist skill and considerable time. A digital process which facilitates the rapid, cost effective production of a light, comfortable, unobtrusive nasal obturator is described.

3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation.

OBJECTIVE: We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture. METHODS: We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor. For all-around tumor-free margins, we grew the tumor by 2 cm. The replacement implant was designed in 3D using the anatomical features of the sternum, cartilages, and ribs and manufactured using TiMG 1 powder fusion technology. Physiotherapy was provided prior to and following surgery, and the impact of reconstruction on pulmonary functions was assessed. RESULTS: At surgery, the precise resection, clear margins, and a secure fit were achieved. At follow-up, there was no dislocation, paradoxical movement, change in performance status, or dyspnea. There was a decrease in forced expiratory volume in 1 s (FEV1) from 105% prior to surgery to 82% following surgery and in forced vital capacity (FVC) from 108% to 75%, with no difference in the FEV1/FVC ratio, suggesting a restrictive pattern of impairment. CONCLUSIONS: With 3D printing technology, reconstructing a large anterior chest wall defect with a custom-made, anatomical, 3D-printed titanium alloy implant is feasible and safe, and it preserves the shape, structure, and function of the chest wall, albeit with a restrictive pattern of pulmonary function, which can be addressed with physiotherapy.

Development and surgical application of a custom implant that enables a vertical vector of mandibular distraction.

Hemifacial microsomia is a congenital malformation that involves the underdevelopment of the mandible and the ear leading to facial asymmetry. Distraction osteogenesis is the gold standard surgical procedure for severe cases of hemifacial microsomia in which two sectioned bone parts are lengthened gradually to promote bony infill. The final shape of the bone depends on the position of the distractor and the vector of distraction. This article presents a complex clinical case of a 7-year-old patient with severe hemifacial microsomia that required distraction to correct mandibular asymmetry. Digital technology was applied to virtually plan the surgery pre-operatively. Optimal symmetrisation required a vertical vector of distraction that none of the 'off-the-shelf' distractors could provide. Consequently, a three-dimensional printed titanium implant was designed as a spacer to be attached to the inferior plate of a standard distractor, allowing the achievement of a vertical vector. By adding the spacer, the inferior footplate of the distractor was not directly fixed to bone and the vector of distraction was not dictated by the anatomical contour of the patient but by the shape of the spacer. Surgical guides were created to translate the virtual plan to the operating room. The guides prevented potential damage to tooth buds and the inferior alveolar nerve. This article describes the three-dimensional computer-aided design and additive manufacture of the custom devices that delivered the following: (1) symmetrisation of the mandible after distraction surgery without manipulation of the healthy side of the mandible; (2) a feasible and safer surgical solution; and (3) an innovative method that enables a wider range of vectors of distraction, bringing new prospects to the treatment of distraction osteogenesis in the future.

Orofacial rehabilitation with zygomatic implants: CAD-CAM bar and magnets for patients with nasal cancer after rhinectomy and partial maxillectomy.

Nasal carcinoma extending into the premaxilla requires radical surgical excision including rhinectomy and partial maxillectomy. Rehabilitation is complex and involves the use of removable prostheses. Three patients treated with zygomatic implants and custom-milled bars to retain an obturator and nasal prosthesis are presented.