3D modelling and printing
4Pages

Case study RENISHAW. apply innovation™ 3D modelling and printing - saving theatre time and providing excellent patient outcome Customers: Mr Cellan Thomas and Mr Liam Addy Industry: Medical and healthcare Challenge: A patient who suffered cancer of the lower jaw required removal of the affected region coupled with reconstructive work. Solution: To use a digital work-flow and pre-planning processes to optimise operating theatre productivity with excellent surgical results. Executive summary Complex reconstructive surgery can significantly benefit from a digital workflow and pre-planning processes to help optimise operating theatre productivity with excellent surgical results. In a recent project, Renishaw used its additive manufacturing (metal 3D printing) expertise to help the University Hospital of Wales (UHW) treat a patient who suffered cancer of the lower jaw and required removal of the affected region coupled with reconstructive work. Background The patient, a male in his 60s, was presented to UHW as a newly diagnosed oral cancer patient needing surgery to remove the left side of his lower jaw and reconstruction using the fibula bone from one of his legs. Handling his case were maxillofacial surgeon Mr Cellan Thomas and restorative dentistry consultant Mr Liam Addy. The operation would require a perfect fit between two harvested sections of fibula bone and the two remaining healthy sections of the jaw. A mandibular plate implant would be required to hold all four sections together, in order for the bone to heal and knit together. Planning for the removal of the cancerous tissue and the reconstruction was done on a CAD/CAM suite with members of the surgical team. This team approach was integral to the success of the treatment. Challenge Mandibular implant operations are relatively rare and complex procedures that require a large surgical team. This case would involve up to ten people in theatre. Mr Thomas and Mr Addy wanted to control as many of the variables as possible that can arise in the environment of the operating theatre. They wanted to perform the operation with accuracy and reduce the risks that can arise from traditional freehand surgery. They chose to specify 3D printed implants, and cutting and drilling guides. They also pre-planned how they would approach the surgery. The project broke new ground because it provided an alternative to the way a hospital would usually approach this type of surgery. Most hospitals still rely on in-house prosthetic teams manufacturing their own implants using traditional methods. Hand forming and welding complex components can run the risk of parts breaking off in mid-surgery.

Fibula sections with cutting guides attached Fibular sections after cutting and drilling UHW was unwilling to face that risk. Additive manufacturing allowed the specific and complex geometries of each component to be produced and built as single pieces. That control would be essential, partly to minimise the amount of bone and material extracted to prevent morbidity, but also to harvest the best bone and soft tissue to ensure a healthy blood supply in the rebuilt jaw and so aid a fast recovery. Solution Mr Thomas and Mr Addy chose to collaborate with a world leading design consultancy and...

Pilot holes were pre-drilled into the two sections of fibula bone before removing them. Mr Thomas was aided by the cutting guide and key, which corresponded with the implant screw holes. This stage of the operation resulted in two bone pieces cut at precisely the correct angles to build a strong joint and aid the osseointegration. When the bones were assembled to reform the mandible, there were minimal gaps between bone sections to aid good integration and recovery. With freehand work, this outcome would have been difficult to achieve. To aid Mr Thomas in removing the damaged jaw section,...

Bernard and Gill Thomas on their wedding day one month after surgery Results The operation ran smoothly with no complications and the patient made a good recovery, enabling him to have restorative dental surgery with implants and bridges after the bone had knitted together. Within weeks of the operation, he was getting married and said he was delighted with the results. This complex operation was delivered with accuracy that ensured patient safety throughout the procedure and delivered much-needed efficiencies in the operating theatre. This successful operation has shown beneficial outcomes...