Three-Dimensional Printing and Its Applications in Otorhinolaryngology–Head and Neck Surgery

Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology–head and neck surgery, discusses future innovations, and explores the financial impact of these advances. Data Sources Articles were identified from PubMed and Ovid MEDLINE. Review Methods PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models. Conclusions Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices. Implications for Practice After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes.

[1]  R. Howell,et al.  Mechanical Modeling of the Human Cricoid Cartilage Using Computer-Aided Design , 2016, The Annals of otology, rhinology, and laryngology.

[2]  Hui-min Chen,et al.  Surgical Reconstruction of Maxillary and Mandibular Defects Using a Printed Titanium Mesh. , 2015, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[3]  Ryan Klatte,et al.  Novel application of rapid prototyping for simulation of bronchoscopic anatomy. , 2014, Journal of cardiothoracic and vascular anesthesia.

[4]  Kazutoshi Fujita,et al.  Three-dimensional mock-up model for chondral framework in auricular reconstruction, built with a personal three-dimensional printer. , 2014, Plastic and reconstructive surgery.

[5]  Isabelle Borget,et al.  Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. , 2016, Surgery.

[6]  Su A Park,et al.  Tissue-engineered tracheal reconstruction using three-dimensionally printed artificial tracheal graft: preliminary report. , 2014, Artificial organs.

[7]  Adir Cohen,et al.  Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. , 2009, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[8]  J. Levine,et al.  Digital technologies in mandibular pathology and reconstruction. , 2012, Atlas of the oral and maxillofacial surgery clinics of North America.

[9]  S. Hollister,et al.  Computer Aided–Designed, 3-Dimensionally Printed Porous Tissue Bioscaffolds for Craniofacial Soft Tissue Reconstruction , 2013, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[10]  Kyle W. Binder In situ bioprinting of the skin , 2011 .

[11]  Todd A. Goldstein,et al.  Introducing a 3-dimensionally Printed, Tissue-Engineered Graft for Airway Reconstruction , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[12]  J. Levine,et al.  Jaw in a Day: Total Maxillofacial Reconstruction Using Digital Technology , 2013, Plastic and reconstructive surgery.

[13]  Frederik L. Giesel,et al.  3D printing based on imaging data: review of medical applications , 2010, International Journal of Computer Assisted Radiology and Surgery.

[14]  Cyrus T. Manuel,et al.  Estimation of Nasal Tip Support Using Computer-Aided Design and 3-Dimensional Printed Models. , 2016, JAMA facial plastic surgery.

[15]  Marc E. Nelson,et al.  Bioresorbable airway splint created with a three-dimensional printer. , 2013, The New England journal of medicine.

[16]  Vicknes Waran,et al.  Neurosurgical Endoscopic Training via a Realistic 3-Dimensional Model With Pathology , 2015, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[17]  J. Lewis,et al.  3D Bioprinting of Vascularized, Heterogeneous Cell‐Laden Tissue Constructs , 2014, Advanced materials.

[18]  Hidetoshi Takahashi,et al.  Clinical application of a custom-made bioresorbable raw particulate hydroxyapatite/poly-l-lactide mesh tray for mandibular reconstruction , 2010, Odontology.

[19]  Sanjay P. Prabhu,et al.  Antenatal Three-Dimensional Printing of Aberrant Facial Anatomy , 2015, Pediatrics.

[20]  Vairavan Narayanan,et al.  Endoscopic skull base training using 3D printed models with pre-existing pathology , 2014, European Archives of Oto-Rhino-Laryngology.

[21]  Paul G. McMenamin,et al.  Emerging Applications of Bedside 3D Printing in Plastic Surgery , 2015, Front. Surg..

[22]  Ibrahim T. Ozbolat,et al.  Bioprinting Toward Organ Fabrication: Challenges and Future Trends , 2013, IEEE Transactions on Biomedical Engineering.

[23]  Vivian K. Lee,et al.  Printing of Three-Dimensional Tissue Analogs for Regenerative Medicine , 2016, Annals of Biomedical Engineering.

[24]  Benjamin M Wu,et al.  Recent advances in 3D printing of biomaterials , 2015, Journal of Biological Engineering.

[25]  Mark A. Skylar-Scott,et al.  Three-dimensional bioprinting of thick vascularized tissues , 2016, Proceedings of the National Academy of Sciences.

[26]  Caroline E. Webster,et al.  Multi-material 3D Models for Temporal Bone Surgical Simulation , 2015, The Annals of otology, rhinology, and laryngology.

[27]  Bertram Unger,et al.  Comparison of cadaveric and isomorphic three‐dimensional printed models in temporal bone education , 2015, The Laryngoscope.

[28]  A. Kane,et al.  Liquid Latex Molding: A Novel Application of 3D Printing to Facilitate Flap Design , 2017, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[29]  John Winder,et al.  A review of the issues surrounding three-dimensional computed tomography for medical modelling using rapid prototyping techniques , 2010 .

[30]  M Daniel,et al.  Frontal sinus models and onlay templates in osteoplastic flap surgery , 2010, The Journal of Laryngology & Otology.

[31]  Alessandro Marro,et al.  Three-Dimensional Printing and Medical Imaging: A Review of the Methods and Applications. , 2016, Current problems in diagnostic radiology.

[32]  H. H. Malik,et al.  Three-dimensional printing in surgery: a review of current surgical applications. , 2015, The Journal of surgical research.

[33]  Yahya E Choonara,et al.  3D-printing and the effect on medical costs: a new era? , 2016, Expert review of pharmacoeconomics & outcomes research.

[34]  D. Cho,et al.  Human turbinate mesenchymal stromal cell sheets with bellows graft for rapid tracheal epithelial regeneration. , 2015, Acta biomaterialia.

[35]  Scott J. Hollister,et al.  Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients , 2015, Science Translational Medicine.

[36]  Ahmad B. AlAli,et al.  Three-Dimensional Printing Surgical Applications , 2015, Eplasty.

[37]  B. Pukenas,et al.  Three-Dimensional Printed Modeling of an Arteriovenous Malformation Including Blood Flow. , 2016, World neurosurgery.

[38]  John R. Tumbleston,et al.  Continuous liquid interface production of 3D objects , 2015, Science.

[39]  Sydney S. Cash,et al.  Streamlined, Inexpensive 3D Printing of the Brain and Skull , 2015, PloS one.

[40]  Roger J. Narayan,et al.  Stereolithography in tissue engineering , 2014, Journal of Materials Science: Materials in Medicine.

[41]  John L Ricci,et al.  Three-Dimensional Printing of Bone Repair and Replacement Materials: Impact on Craniofacial Surgery , 2012, The Journal of craniofacial surgery.

[42]  R. Grunert,et al.  ElePhant - An anatomical Electronic Phantom as simulation-system for otologic surgery , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[43]  Jin-yong Cho,et al.  Bilateral Temporomandibular Joint Replacement Using Computer-Assisted Surgical Simulation and Three-Dimensional Printing. , 2016, The Journal of craniofacial surgery.

[44]  Dong-Woo Cho,et al.  A novel tissue-engineered trachea with a mechanical behavior similar to native trachea. , 2015, Biomaterials.

[45]  Su A. Park,et al.  Tissue-engineered artificial oesophagus patch using three-dimensionally printed polycaprolactone with mesenchymal stem cells: a preliminary report. , 2016, Interactive cardiovascular and thoracic surgery.

[46]  P. Camarata,et al.  Individualized Surgical Approach Planning for Petroclival Tumors Using a 3D Printer , 2015, Journal of Neurological Surgery—Part B.

[47]  Jayanthi Parthasarathy,et al.  3D modeling, custom implants and its future perspectives in craniofacial surgery , 2014, Annals of maxillofacial surgery.

[48]  Bruce L. Tai,et al.  A physical simulator for endoscopic endonasal drilling techniques: technical note. , 2016, Journal of neurosurgery.

[49]  A. Zaretski,et al.  V-stand--a versatile surgical platform for oromandibular reconstruction using a 3-dimensional virtual modeling system. , 2015, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[50]  Three-Dimensional Printed Prosthesis for Repair of Superior Canal Dehiscence , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[51]  Bethany C Gross,et al.  Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences. , 2014, Analytical chemistry.

[52]  Caroline E. Webster,et al.  Pre-operative simulation of pediatric mastoid surgery with 3D-printed temporal bone models. , 2015, International journal of pediatric otorhinolaryngology.

[53]  I. Ono,et al.  Producing a full-scale model from computed tomographic data with the rapid prototyping technique using the binder jet method: a comparison with the laser lithography method using a dry skull. , 2000, The Journal of craniofacial surgery.

[54]  Joss C. Cohen,et al.  Creation of a 3D printed temporal bone model from clinical CT data. , 2015, American journal of otolaryngology.

[55]  André R Studart,et al.  Additive manufacturing of biologically-inspired materials. , 2016, Chemical Society reviews.

[56]  David G. Armstrong,et al.  Three-dimensional printing surgical instruments: are we there yet? , 2014, The Journal of surgical research.

[57]  John J. Rosowski,et al.  Design, fabrication, and in vitro testing of novel three-dimensionally printed tympanic membrane grafts , 2016, Hearing Research.

[58]  Bo Zhang,et al.  Tissue Engineering of Human Nasal Alar Cartilage Precisely by Using Three-Dimensional Printing , 2015, Plastic and reconstructive surgery.

[59]  C. L. Ventola Medical Applications for 3D Printing: Current and Projected Uses. , 2014, P & T : a peer-reviewed journal for formulary management.

[60]  James A. Owusu,et al.  Update of patient-specific maxillofacial implant , 2015, Current opinion in otolaryngology & head and neck surgery.

[61]  M. Newman,et al.  Three-Dimensional Printing in Plastic and Reconstructive Surgery: A Systematic Review , 2016, Annals of plastic surgery.

[62]  P. Liacouras,et al.  Custom Anatomical 3D Spacer for Temporomandibular Joint Resection and Reconstruction , 2016, Craniomaxillofacial trauma & reconstruction.

[63]  Yuki Kanno,et al.  Maxillofacial reconstruction using custom-made artificial bones fabricated by inkjet printing technology , 2009, Journal of Artificial Organs.

[64]  Ali Khademhosseini,et al.  3D Bioprinting for Tissue and Organ Fabrication , 2016, Annals of Biomedical Engineering.

[65]  E. Gasparetto,et al.  Virtual bronchoscopy for evaluating cervical tumors of the fetus , 2013, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[66]  C. Solares,et al.  A Novel Temporal Bone Simulation Model Using 3D Printing Techniques , 2015, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[67]  Nigel W. John Segmentation of Radiological Images , 2008 .

[68]  David A Zopf,et al.  Computer-Aided Design and 3D Printing to Produce a Costal Cartilage Model for Simulation of Auricular Reconstruction , 2016, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[69]  Yaoyao Fiona Zhao,et al.  Energy and Material Flow Analysis of Binder-jetting Additive Manufacturing Processes , 2014 .

[70]  H. Francis,et al.  Face and content validation of a novel three-dimensional printed temporal bone for surgical skills development , 2015, The Journal of Laryngology & Otology.

[71]  P. V. van Zuijlen,et al.  Developing a parametric ear model for auricular reconstruction: a new step towards patient-specific implants. , 2015, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.