Sirris materials day 2011 rapd manufacturing in medicine - prof poukens

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Using rapid manufacturing to reconstruct facial damage and scull fractures

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Sirris materials day 2011 rapd manufacturing in medicine - prof poukens

  1. 1. RAPID MANUFACTURING IN MEDICINE Prof. dr. Jules Poukens Prof. dr. Ivo LambrichtsUniversity Hasselt, Dep. Basic Medical Science, BelgiumMaastricht UniversityMedical Center Sittard / Heerlen, the Netherlands
  2. 2. OVERVIEW OF PRESENTATION1 DESCRIPTION CLINICAL DEFECTS2 RECONSTRUCTION PAST AND PRESENT3 CASE STUDY SKULL DEFECT4 CASE STUDY TEMPERO-MANDIBULAR JOINT5 CASE STUDY MANDIBULAR DEFECT6 CONCLUSION
  3. 3. WHAT ARE CRANIO-MAXILLOFACIAL DEFECTS ?
  4. 4. GOOD OLD FASHIONED WAY PRE-OPERATIVE MANUFACTURED IMPLANT CT SCAN RAPID PROTOTYPING MODEL IMPLANT PMMA INJECTION MOULDEDMANUAL MANUFACTURED WAX MODEL
  5. 5. SHIFT IN MEDICAL TREATMENT– Standard design to customized design– Computer assistance in design and manufacturing of implants (CAD-CAM) 5
  6. 6. SIMPLANT CMF SOFTWARESEGMENTATION VISUALISATION
  7. 7. 3D VISUALISATION OF BONE AND SOFT TISSUE
  8. 8. Case studySKULL DEFECT
  9. 9. RAPID PROTOTYPING MODELONLY FOR VALIDATION OF IMPLANT
  10. 10. PATIENTYoung girl- Car accident with large skull defect- Reconstruction with titanium implant (electron beam melting)
  11. 11. DESIGN
  12. 12. Final design
  13. 13. ImplantTi6Al4V ELECTRON BEAM MELTING (ARCAM)
  14. 14. Now follows operation video and picsNot suited for sensitive viewers !
  15. 15. VIDEO SKULL
  16. 16. EXAMPLE CLINICAL RESULT
  17. 17. Case StudyCUSTOM TEMPERO-MANDIBULAR JOINT IMPLANT
  18. 18. Anatomy TMJ FOSSA CONDYLE
  19. 19. Diseases involving condylar bone lossOsteoarthrosis CancerCongenital Removal former implants
  20. 20. FOSSA part• Titaniumsheet with 4 layers titanium mesh (custom fit) – Purpose: allow bone and soft tissue ingrowth → maximize long- term stability of the fossa• UHMW polyethylene with posterior stop – Flat functional surface – Provide a centric relation posititon for the condyle
  21. 21. CONDYLE part• Shaft: titanium (custom fit)• Head: cobalt-chrome molybdene
  22. 22. Manufacturing (TMJ Concepts, USA)• Construction of TMJ prosthesis
  23. 23. Manufacturing
  24. 24. Manufacturing
  25. 25. Surgical technique• Approach: preauricular incision
  26. 26. Surgical technique• Applying fossa – Fixation to zygomatic arch – 3-4 titanium screws 2.0mm
  27. 27. Surgical technique• Applying mandible part – Fixation with 4-12 titanium screws 2.0mm Poukens- Lambrichts
  28. 28. Surgical technique• Fitting condyle in fossa• Manipulating mandibula to check movement possibilities
  29. 29. Case StudyMANDIBULAR IMPLANT
  30. 30. Patient• Female , 83years old• Patient visited the out-patient clinic with a large purulent wound on the chin• Diagnosis : massive osteomyelitis of the mandible caused by tooth infection
  31. 31. Pre-operative
  32. 32. Anatomy (muscles) Movement of temporomandibular joint
  33. 33. Current treatment I• Free Bone transplants• Vascularized bone transplants • Rib • Iliac crest • Radius • Fibula
  34. 34. Current treatment IICustom bended reconstruction plate with condylar head part
  35. 35. Custom-made implant
  36. 36. Custom-made implant Design I
  37. 37. Custom-made implant
  38. 38. Custom-made implant
  39. 39. Hydroxy-apatite coating
  40. 40. Video• ALERT!!! Not suited for sensitive viewers
  41. 41. VIDEO
  42. 42. POSTOP
  43. 43. “ CONCLUSIONComputer aided engineering applied tomedicine: Thats one small step for anengineer, one giant leap in medicalhistory"
  44. 44. Thanks for your attention

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