Stephen Power, a 29-year-old father from Cardiff in the UK, was left with extensive facial injuries after a motorbike crash. Now thanks to pioneering use of 3D printing, surgeons were able to repair his face in a boundary-pushing reconstructive procedure that took months to plan and 8 hours to complete.
The crash, which occurred in September 2012, broke both Mr. Power’s arms and his right leg, both cheek bones, both eye sockets, and his upper jaw. It also fractured his skull.
He underwent emergency surgery at Morriston Hospital in Swansea, some 36 miles from where the crash occurred in Llantwit Major. His limb injuries were so serious they required attention from a team of trauma, orthopedic and plastic surgeons. He needed a bone graft for his right leg.
The surgeons did a good a job on his facial injuries, but they could not fully repair his left cheek and eye socket, as consultant maxillofacial surgeon Adrian Sugar explains:
“We fixed his facial fractures pretty well but he had damaged his left eye and the ophthalmologists did not want us to do anything that might damage his sight further.”
As Mr. Power’s eyesight has mostly recovered, this proved to be a good decision. But, Sugar adds, “as a result we did not get his left cheekbone in the right place and we did not even try to reconstruct the very thin bones around his eye socket.”
Mr. Power was consequently left with a distorted face – his left cheekbone was out of place and his left eye remained sunk in and lower than his right eye.
So Mr. Sugar and a team got together to “virtually plan” the surgery to restore symmetry to Mr. Power’s face.
Using scanned 3D images of his face, they designed guides to cut and re-position the bones, and plates to hold them in place. All the models – including the guides and titanium implants – were made using 3D printing.
“We did two types of model planning – virtual model planning on a computer screen and physical model planning,” Mr. Sugar explains, “Also we produced guides at each stage of the surgical process, not only to cut the bone but to reposition the bones, and then we had custom implants 3D printed.”
He says that without the help of such advanced technology they would have to work freehand and “guess” where everything goes. “The technology allows us to be far more precise and get a better result for the patient,” he adds.
Both surgeons and patient are pleased with the results of the operation. Mr. Power’s cheekbone is in a better position, and the eye is not sunken any more, although it is slightly raised – but that might settle in the next few months, says Mr. Sugar.
Before his pioneering surgery, Mr. Power had continued to wear glasses to disguise his cheek and eye, even though his vision had been improving. He said then that he was hoping the surgery would mean he would not have to hide his face and he would get his confidence back – he would be able to do everyday things, see people and go out in public.
After the operation, Mr. Power said:
“To be honest I thought they did a good job in the beginning anyway because of how bad my accident was. But from this operation I can’t really explain how well it has gone. It has just made me look a lot better. I take my hat off to them.”
He gave the operation a 9 out of 10. “I’m glad he’s not given us 10,” says Mr. Sugar, “because if he did, we would not have any way of getting better.”
Mr. Power is still not fully recovered from his overall physical injuries, but his facial reconstruction has been successful, and opens the door for the techniques to help others. Mr. Sugar says they did not take 3D technology just one step further, but two, and perhaps even three steps further. He explains:
“Previous efforts elsewhere to take it to this step have failed and so we have had to learn from those experiences. This is really the first time we’ve taken it to this stage, where everything to the very last screws being inserted has been planned and modelled in advance – and worked sweetly.”
He says while it took months to plan it this time, next time it will take nowhere near as long.
“We’re talking maybe days as opposed to months. The ultimate aim is to undertake planning and be able to use custom-made guides and implants on a routine basis,” he adds.
He says the more experienced they become, the cheaper it will get, which will help to spread the expertise to “any surgeon who finds themselves with this kind of problem.”
The 3D reconstruction project was the work of the Centre for Applied Reconstructive Technologies in Surgery, which is a partnership between Morriston Hospital’s Maxillofacial Unit and the National Centre for Product Design and Development Research at Cardiff Metropolitan University.
In September 2013, Medical News Today learned how virtual surgical planning using 3D models and custom hardware allows for complex maxillofacial reconstruction. In a paper published in the journal Plastic and Reconstructive Surgery, a team of surgeons from the US reported their experience with maxillofacial reconstruction in patients with severe facial defects.