A 3-dimensional–printed short-segment template prototype for mandibular fracture repair

Parul Sinha, Gary Skolnick, Kamlesh B. Patel, Gregory H. Branham, John J. Chi

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

IMPORTANCE After reduction of complex mandibular fractures, contouring of the fracture plates to fixate the reduced mandibular segments can be time-consuming. OBJECTIVE To explore the potential application of a 3-dimensional (3-D)-printed short-segment mandibular template in the management of complex mandibular fractures. DESIGN, SETTING, AND PARTICIPANTS A feasibility study was performed at a tertiary academic center using maxillofacial computed tomography data of 3 patients with comminuted mandibular fractures who required preoperative planning with a perfected complete mandible model. INTERVENTIONS Thresholding, segmentation, and realignment of the fractured mandible were performed based on computed tomography data. Each reduced mandible design was divided to create 3-D templates for 6 fracture sites: right and left angle, body, and symphyseal/parasymphyseal. Sessions were conducted with junior otolaryngology and plastic surgery residents, during which mandibular fracture plates were contoured in a “preoperative” setting against the 3-D–printed short-segment templates, and an “intraoperative” setting against the previously manufactured, complete mandible model. The previously manufactured, complete model served as a surrogate for the intraoperative mandible with the fracture site reduced. MAIN OUTCOMES AND MEASURES The time for 3-D template printing, the “preoperative” (measure of the time consumed preoperatively), and “intraoperative” (measure of the time saved intraoperatively) times were recorded. Comparisons were made for cost estimates between a complete model and the 3-D–printed short-segment template. The operating room charge equivalent of the intraoperative time was also calculated. RESULTS Of the 3 patients whose data were used, 1 was a teenager and 2 were young adults. The total time for 3-D modeling and printing per short-segment template was less than 3 hours. The median (range) intraoperative time saved by precontouring the fracture plates was 7 (1-14), 5 (1-30), and 7 (2-15) minutes, and the operating room charge equivalents were $350.35 ($50.05-$700.70), $250 ($50.05-$1501.50), and $350.35 ($100.10-$750.75) for the angle, body, and symphyseal/parasymphyseal segments, respectively. The total cost for a single 3-D–printed template was less than $20, while that for a perfected complete model was approximately $2200. CONCLUSIONS AND RELEVANCE We demonstrate that patient- and site-specific 3-D–printed short-segment templates can be created within the timeframe required for mandibular fracture repair. These novel 3-D–printed templates also demonstrate cost efficiency in the preoperative planning for complex mandibular fracture management compared with perfected models and facilitate plate contouring in a similar fashion. Estimation of reduced operative room cost and time with the application of these short-segment templates warrants studies in actual patient care.

Original languageEnglish
Pages (from-to)373-380
Number of pages8
JournalJAMA facial plastic surgery
Volume20
Issue number5
DOIs
StatePublished - Sep 1 2018

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