Using rapid manufacturing to reconstruct facial damage and scull fractures

1. RAPID MANUFACTURING IN MEDICINE
Prof. dr. Jules Poukens
Prof. dr. Ivo Lambrichts
University Hasselt, Dep. Basic Medical Science, Belgium
Maastricht University
Medical Center Sittard / Heerlen, the Netherlands

2. OVERVIEW OF PRESENTATION
1 DESCRIPTION CLINICAL DEFECTS
2 RECONSTRUCTION PAST AND PRESENT
3 CASE STUDY SKULL DEFECT
4 CASE STUDY TEMPERO-MANDIBULAR JOINT
5 CASE STUDY MANDIBULAR DEFECT
6 CONCLUSION

3. WHAT ARE CRANIO-MAXILLOFACIAL DEFECTS ?

4. GOOD OLD FASHIONED WAY
PRE-OPERATIVE MANUFACTURED IMPLANT
CT SCAN RAPID PROTOTYPING MODEL
IMPLANT PMMA INJECTION MOULDED
MANUAL MANUFACTURED WAX MODEL

5. SHIFT IN MEDICAL TREATMENT
– Standard design to customized design
– Computer assistance in design and
manufacturing of implants (CAD-CAM)
5

6. SIMPLANT CMF SOFTWARE
SEGMENTATION VISUALISATION

7. 3D VISUALISATION OF BONE AND SOFT TISSUE

8. Case study
SKULL DEFECT

10. RAPID PROTOTYPING MODEL
ONLY FOR VALIDATION OF IMPLANT

11. PATIENT
Young girl
- Car accident with large skull defect
- Reconstruction with titanium
implant
(electron beam melting)

14. DESIGN

15. Final design

16. Implant
Ti6Al4V
ELECTRON BEAM MELTING
(ARCAM)

17. Now follows operation video and pics
Not suited for sensitive viewers !

19. VIDEO SKULL

20. EXAMPLE CLINICAL RESULT

22. Case Study
CUSTOM TEMPERO-MANDIBULAR
JOINT IMPLANT

23. Anatomy TMJ
FOSSA
CONDYLE

24. Diseases involving condylar bone loss
Osteoarthrosis Cancer
Congenital Removal former implants

25. 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

26. CONDYLE part
• Shaft: titanium
(custom fit)
• Head: cobalt-chrome
molybdene

27. Manufacturing
(TMJ Concepts, USA)
• Construction of TMJ prosthesis

28. Manufacturing

29. Manufacturing

30. Surgical technique
• Approach: preauricular incision

31. Surgical technique
• Applying fossa
– Fixation to zygomatic arch
– 3-4 titanium screws 2.0mm

32. Surgical technique
• Applying mandible part
– Fixation with 4-12 titanium
screws 2.0mm
Poukens- Lambrichts

33. Surgical technique
• Fitting condyle in fossa
• Manipulating mandibula to
check movement possibilities

34. Case Study
MANDIBULAR IMPLANT

35. 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

36. Pre-operative

37. Anatomy (muscles)
Movement of temporomandibular joint

38. Current treatment I
• Free Bone transplants
• Vascularized bone transplants
• Rib
• Iliac crest
• Radius
• Fibula

39. Current treatment II
Custom bended reconstruction plate with condylar
head part

40. Custom-made implant

41. Custom-made implant
Design I

42. Custom-made implant

43. Custom-made implant

44. Hydroxy-apatite coating

45. Video
• ALERT!!!
Not suited for sensitive viewers

46. VIDEO

47. POSTOP

48. “
CONCLUSION
Computer aided engineering applied to
medicine: That's one small step for an
engineer, one giant leap in medical
history"

49. Thanks for your attention