PHILADELPHIA – For five years, Jefferson University Hospital surgeons have been traveling to Haiti to rebuild the jaws of patients whose faces are disfigured by benign, yet massive tumors. These are delicate operations, made all the more challenging because the doctors cannot see what they are dealing with until they arrive in a sparsely equipped operating room in Port-au-Prince and meet their patients.
This time they tried a new tactic: making models of the patients’ jaws in advance, with 3-D printers in Philadelphia.
The idea was to use the plastic models as a guide, allowing the physicians to bend titanium surgical plates in the exact shape of each patient’s jawbone — a task normally done during surgery. Shaping the plates in advance would save up to an hour in the operating room, reducing time under anesthesia, the risk of infection, and other complications, and it also would help the surgeons achieve a more faithful reconstruction of each patient’s original anatomy.
The concept is unusual even in the United States. Jefferson physicians have been making jaw models for this type of surgery only for the past year and a half, using a suite of printers housed in a former bank vault in Philadelphia.
For patients in poverty-stricken Haiti, the high-tech advance was like something from another world.
“It was life-changing,” said Patrick Jean-Gilles, chief resident of the ear, nose and throat/head and neck surgery department at Haiti State University Hospital.
Jean-Gilles sent discs containing three patients’ CT scans to Jefferson in early January, and Robert S. Pugliese, director of Jefferson’s Health Design Lab, got to work. Assisted by medical students, he converted the scans into computer files that could be interpreted by the lab’s printers. Then he kept watch for days as the printer nozzles glided back and forth, depositing layer after layer of plastic in the shape of the patients’ jaws.
Though invented decades ago, 3-D printers have only recently begun to transform medicine as the cost of the boxy machines has declined. Some physicians use printed models of body parts as a visual aid, planning the best approach for surgery when a patient’s anatomy is especially complex. Others use printers to fashion actual devices to be implanted. Those typically are made from plastic and other inert materials, though increasingly, researchers are experimenting with devices that can “print” cartilage and other living tissue.
A printed model of a jawbone lies somewhere in between. It can help in visualizing the best strategy for a surgery, and it also serves as a template for bending the titanium plate that is screwed into what remains of a jaw eroded by a tumor.
Jefferson surgeons have used this technique on two dozen U.S. patients so far, and they say it is especially useful for patients in Haiti, some of whose tumors are so large that the bone beneath has been destroyed. In the case of a 26-year-old Haitian woman whose right jaw was gone, physicians planned to bend the metal in a mirror image of her left jaw, said Joseph M. Curry, a Jefferson surgeon who is a co-leader of the Haiti project.
The various benign tumors of the jaw are no more common in Haiti than in the U.S., but here they typically are removed while still small. In Haiti, where such surgeries were not readily available until recently, some patients’ tumors have grown to half the size of their faces. They need both a delicate tumor removal and also a complex reconstructive procedure that is not yet performed by Haitian physicians.