Craniomaxillofacial surgeons perform major structural surgeries that involve bones and soft tissues (skin and muscle) in the head and neck area. The complex anatomy of the craniofacial skeleton presents a challenge when attempting to achieve the ideal aesthetic and functional outcomes.
A 22 year-old female suffering from left orbital fracture after falling from the 2nd floor was admitted to the Craniomaxillofacial Surgery unit at Galilee Medical Center in Nahariya, Israel, headed by Prof. Samer Saruji. It was decided to create an implant in order to reconstruct the missing part in her left orbit.
“Due to the complexity of the fracture and its delicate location, one of the
challenges the team faced was to achieve optimal fitting of the implant to
the patient’s anatomy while preserving its functionality and highest
aesthetic results,” said Dr. Lior Tzadok, Senior Craniomaxillofacial
Surgeon, Galilee Medical Center.
Six months ago, the institution initiated a surgical planning workflow using
Oqton’s surgical planning software applications and a 3D printer.
The ability to use a few products from the same company helped us
achieve a faster and smoother process to the end result, without wasting
time between the workflow steps
Dr. Adib Zoabi, Craniomaxillofacial Fellow, Galilee Medical Center
“Using D2P software, we were able to segment the replicate structures
out of the patient’s CT scan and send it for printing in our 3D lab (CJP 460
printer, 3D Systems). The printed gypsum model allowed us to better
understand the patient’s pathology. Using Oqton’s Freeform design
software, we mirrored the healthy side, shaped the implant and sent the
implant file to 3D Systems’ FDA and CE registered facility in Leuven,
Belgium and received a Patient Specific titanium Implant (PSI),” said Dr.
In addition to surgical planning, the physicians used the printed gypsum
model to verify the titanium implant fitting and explained to the patient
and family the severity of the problem and outline the surgery plan and
the expected result.
Since the technology enables us to accurately predict and reach the
result as we planned, it is now easier for us to share the surgical plan with
the patient and his family.
This has also a positive effect on the patient’s understanding and trust.
“The physician showed me the printed model of my healthy and fractured
orbit. I didn’t realize the magnitude of the problem until I saw the fracture
size. I could not understand it by looking at the CT,” said the patient.
“After the physician’s explanation about the procedure and seeing the
implant, I felt more confident to have the surgery.”
Reconstructive surgery has historically relied on the surgeon’s subjective
assessment of form and aesthetics preoperatively and intraoperatively,
with intraoperative decision making based on visual anatomical
inspection, after bending the metal plate implant. Although good
outcomes can and are often achieved, the highly subjective nature of this
process results in variable surgeon-specific outcomes and can also lead to
prolonged surgical time.
“The surgery was smooth and quick, and the result was beyond our
expectations,” said Dr. Tzadok. “The most amazing reaction to the
planning was received in the OR. Usually after the surgery, the team was
examining the patient from different angles to see if we brought the
eyeball to its place. We could not know if we were in the correct place
until the next morning’s imaging and this kept us up all night. In this
surgery, immediately when we put the printed plate in place according to
planning, we were all looking and it was obvious that we have the correct
positioning. The eyeballs were exactly where we planned. For surgeons, it
brings something we didn’t have before, knowing the magnitude of the
problem, being able to copy from the healthy side to the pathological side
and to predict the outcome. This minimizes the risk of error, shortens the
operation time and helps us know what will be the final product and
‘promise it’ to our patients.”
The shortened procedure time and the excellent surgical result effect on
the patient was obvious. “The operation was quick and almost painless,
except for a slight pain in one eye. I was released two days later. There
was no scar and no one knows I had an eye operation, which is amazing.
After three days, I was at home reading books,” said the patient.
Galilee Medical established a 3D printing lab in the craniomaxillofacial
unit. This is the first and currently the only center in Israel that
incorporated in-house end-to-end surgical planning workflow, in which
physicians have the knowhow for using 3D Systems’ surgical planning
applications and 3D printing.
“We are speaking in new terms in the surgical world that are different
from everything we used to know. More and more ‘dry runs’ are
performed before the actual surgery. The surgeon is becoming a
designer,” said Prof. Samer Saruji, Head of CMF Unit, Galilee Medical.
We have just started to use this workflow in our daily practice and we already
see the great progress in our patient outcome. The errors are dramatically
reduced and the surgical ability of the surgeon is constantly improving. In
addition, having those capabilities in-house helps us to reduce procedural
cost. Our success here leads to a growing interest in the hospital to
expand the 3D Lab usage to other departments, such as neurosurgery.
We hope to see this trend improving patient outcomes in more and more
Prof. Samer Saruji
Head of CMF Unit, Galilee Medical