Review of cost and surgical time implications using virtual patient specific planning and patient specific implants in midface reconstruction

Abstract

Aim: Summarize the available data on midfacial virtual patient specific planning and patient specific implants, highlighting the financial costs and savings, and additionally emphasize the potential cost implications of transitioning to “in-house” virtual 3D modeling and printing.

Methods: Review of current literature.

Results: Current literature suggests cost benefits of virtual patient specific planning and patient specific implants in the form of improved ischemia time, better boney apposition between flaps, and reduced patient complications. This reduction of complications includes a reduction in blood loss and time spent in the intensive care unit from flap failure. Improved boney apposition results in a higher likelihood of boney union and a further reduction in failure and complications. Subjective benefits of virtual patient specific planning and patient specific implants are shown in the form of improved reconstructive surgeon mental energy. In-house production of 3D models and presurgical planning provides additional cost benefits for providers as they can produce viable models at a fraction of the price of that which is produced by industrial companies. Providers can also construct and use models in an expedient manner compared to industrial models, allowing for the opportunity to be utilized in more acute settings. The foundation of developing an in-house workflow is adequate funding, resources, and clinical volume. Facilities also must focus on appropriate quality and safety measures, as well as appropriate workflow development for adequate production of models.

Conclusion: Virtual patient specific planning and patient specific implants show benefits in midfacial reconstructive outcomes, resulting in realized financial and temporal gains for both patient and provider. These gains may be enhanced by moving to in-house planning and printing.

Keywords

Virtual patient specific planning / midface / maxillofacial / reconstruction / head and neck / cost / 3D-printing

References

[1] Ballard DH,Duszak R Jr,Rybicki FJ.Medical 3D printing cost-savings in orthopedic and maxillofacial surgery: cost analysis of operating room time saved with 3D printed anatomic models and surgical guides.Acad Radiol2020;27:1103-13 PMCID:PMC7078060

[2] Tack P,Gemmel P.3D-printing techniques in a medical setting: a systematic literature review.Biomed Eng Online2016;15:115 PMCID:PMC5073919

[3] Zweifel DF,Hoarau R,Broome M.Are virtual planning and guided surgery for head and neck reconstruction economically viable?.J Oral Maxillofac Surg2015;73:170-5

[4] Mazzola F,Cheng K.Time and cost-analysis of virtual surgical planning for head and neck reconstruction: a matched pair analysis.Oral Oncol2020;100:104491

[5] Crawley MB,Ravipati P.Factors associated with free flap failures in head and neck reconstruction.Otolaryngol Head Neck Surg2019;161:598-604

[6] Eskander A,Tweel B.Predictors of complications in patients receiving head and neck free flap reconstructive procedures.Otolaryngol Head Neck Surg2018;158:839-47

[7] May MM,O’Byrne TJ.Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: decreased nonunion and complication rates.Head Neck2021;43:2342-52

[8] Swendseid BP,Vimawala S.Virtual surgical planning in subscapular system free flap reconstruction of midface defects.Oral Oncol2020;101:104508

[9] Swendseid B,Sweeny L.Natural history and consequences of nonunion in mandibular and maxillary free flaps.Otolaryngol Head Neck Surg2020;163:956-62

[10] Navarro Cuéllar C,Antúnez-Conde R.Virtual surgical planning, stereolitographic models and CAD/CAM titanium mesh for three-dimensional reconstruction of fibula flap with iliac crest graft and dental implants.J Clin Med2021;10:1922 PMCID:PMC8124267

[11] Seier T,Schumann P,Rücker M.Virtual planning, simultaneous dental implantation and CAD/CAM plate fixation: a paradigm change in maxillofacial reconstruction.Int J Oral Maxillofac Surg2020;49:854-61

[12] Allen RJ Jr,Rosen EB.Immediate dental implantation in oncologic jaw reconstruction: workflow optimization to decrease time to full dental rehabilitation.Plast Reconstr Surg Glob Open2019;7:e2100 PMCID:PMC6382230

[13] Daoud GE,Dolatowski CJ.Establishing a point-of-care additive manufacturing workflow for clinical use.J Mater Res2021;36:3761-80 PMCID:PMC8259775

[14] Bastawrous S,Strzelecki B.Establishing quality and safety in hospital-based 3D printing programs: patient-first approach.Radiographics2021;41:1208-29

[15] Lor LS,Chung SA,Runyan CM.Cost analysis for in-house versus industry-printed skull models for acute midfacial fractures.Plast Reconstr Surg Glob Open2020;8:e2831 PMCID:PMC7605867

[16] Sharkh H, Makhoul N. In-house surgeon-led virtual surgical planning for maxillofacial reconstruction.J Oral Maxillofac Surg2020;78:651-60

[17] Dell’Aversana Orabona G,Maglitto F.Low-cost, self-made CAD/CAM-guiding system for mandibular reconstruction.Surg Oncol2018;27:200-7

[18] Moe J,Herster R.An in-house computer-aided design and computer-aided manufacturing workflow for maxillofacial free flap reconstruction is associated with a low cost and high accuracy.J Oral Maxillofac Surg2021;79:227-36

[19] Louvrier A,Barrabé A.How useful is 3D printing in maxillofacial surgery?.J Stomatol Oral Maxillofac Surg2017;118:206-12

[20] Ma H,Van Dessel J.Adherence to computer-assisted surgical planning in 136 maxillofacial reconstructions.Front Oncol2021;11:713606 PMCID:PMC8322949

[21] Lawless M. Overview of VPSP and PSI benefits (top). Comparative benefits of industrial vs. in-house VPSP and PSI (bottom). Department of Otolaryngology - Head and Neck Surgery, Columbus. OH USA: The Ohio State University Comprehensive Cancer Center; 2022 February 2. Unpublished.

[22] Herster R. In-house 3D-printed Drill Guide [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 275 × 175. Unpublished.

[23] Herster R. In-house 3D-printed Drill Guide (2) [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 270 × 251. Unpublished.

[24] Herster R. In-house 3D-printed Mandible Model with Tumor (yellow) [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 282 × 242. Unpublished.

[25] Herster R. In-House 3D-printed Mandible and Maxilla Models [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 272 × 134. Unpublished.

[26] Herster R. In-house 3D-printed Tracheostomy plug (Left) and Laryngectomy Tube (Right) [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 250 × 207. Unpublished.

[27] Herster R. In-house 3D-printed Wax nose for prosthetic design [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 272 × 256. Unpublished.

[28] Herster R. In-house 3D-printed Auricular Hematoma simulator [digital]. Columbus (OH): Department of Otolaryngology - Head and Neck Surgery. Columbus, OH USA: The Ohio State University Comprehensive Cancer Center; 2022, February 2. 1 Image: color, 215 × 271. Unpublished.