TY - JOUR
T1 - A 3-dimensional–printed short-segment template prototype for mandibular fracture repair
AU - Sinha, Parul
AU - Skolnick, Gary
AU - Patel, Kamlesh B.
AU - Branham, Gregory H.
AU - Chi, John J.
N1 - Funding Information:
Funding/Support: This study was supported by a grant from American Academy of Facial Plastic and Reconstructive Surgery to Dr Chi. Dr Sinha was supported by the Development of Clinician/ Researchers in Academic ENT T32DC00022 grant from the National Institutes of Deafness and Other Communication Disorders, and by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award UL1 TR002345.
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85053821658&partnerID=8YFLogxK
U2 - 10.1001/jamafacial.2018.0238
DO - 10.1001/jamafacial.2018.0238
M3 - Article
C2 - 29710318
AN - SCOPUS:85053821658
SN - 2168-6076
VL - 20
SP - 373
EP - 380
JO - JAMA facial plastic surgery
JF - JAMA facial plastic surgery
IS - 5
ER -