In a split second, her life was changed forever. A car crash, followed by a seven-and-a-half hour surgery. Her left eye couldn’t be saved. Intense scarring had also altered the skull around the area, leaving her with a facial defect she thought she would have to live with for the rest of her life.
To top it all off, she began suffering from severe headaches.
That was life at 52 for Sharifah (not her real name), and it didn’t sound like a very good prelude to her golden years.
Now, 15 months on, Sharifah has never felt and looked better. And it’s all thanks to the latest advancement to grace the local medical field: 3D-printed facial implants.
Sharifah became the first patient in the country to undergo reconstructive surgery using a 3D-printed implant, a new technology poised to redefine the recovery landscape for accident victims with complex cranio-maxillofacial trauma, a term that describes any injury linked to the anatomical area of the mouth, jaws, face and skull, as well as associated structures.
A 3D printer, as the name suggests, prints in three dimensions using data from a digital file. The creation of a 3D-printed object is achieved through an additive process, whereby layers of material are laid down successively until the entire object is produced.
This technique isn’t new as it dates back 30 years. What makes it exciting, though, is that a rise in demand has helped to drastically lower the costs, making it much more accessible to the general public.
Nevertheless, the only technology available to Malaysia prior to this was in the creation of patient-specific 3D-printed surgical models for surgeons to practise on before an actual operation.
According to oral and maxillofacial specialist Dr Mohd Nazimi Abd Jabar of Universiti Kebangsaan Malaysia Medical Centre (UKMMC), the introduction of 3D-printed implants can dramatically cut down surgery time and the need for repeat procedures.
Sharifah’s case came at a time when Materialise, a Belgium-based 3D printing software company, was ready to introduce its expertise in Malaysia.
Tasked to carry out the secondary frontal bone repair on Sharifah, Dr Mohd Nazimi worked closely with engineers from OBL, a sub-company of Materialise, to chart out the surgery, using a combination of the patient’s MRI and CT scan data, and a specialised 3D software.
A custom-made 3D-printed titanium implant, which mimics the properties of real bone, was then designed and shipped from France. Though a lead time of up to four weeks was required to plan for the procedure, the actual surgery only took two-and-a-half hours.
Conventionally, a complex surgery like this would require a transfer of bone from another part of the body, which would then be contoured to fit and match the patient’s existing facial structure. Achieving a 100% anatomical match is often impossible, despite the surgeon’s best efforts in trimming the bone to shape.
Using a custom-fitted implant essentially takes the guesswork out of surgical precision, to the extent of having measurements that are precise to the millimetre.
“You can still perform such a complex surgery without any help from a 3D planning software and 3D-printed implants. But it will be much more challenging, much more risky, and with much more opportunity to fail,” says Dr Mohd Nazimi.
In addition to cosmetic improvements, evident in the corrected eyebrow level, the procedure managed to relieve Sharifah almost entirely of her headaches.
Dr Mohd Nazimi points out that 3D-printed implants, apart from offering a comfortable fit, can also facilitate natural bone growth.
Redefining medical precision
But despite offering groundbreaking results, this medical breakthrough is yet to be viable for surgical procedures across the board. The current hurdle lies in the long lead time needed in laying down the legwork for a surgery.
“The planning stages take a long time because we’re talking about a collaboration between a team of doctors and clinical engineers, all working together to design a solution that would best fit the patient. A lot of time is spent going through every detail to ensure that nothing goes wrong on the day of the surgery,” says Dr Mohd Nazimi.
While the same technology can be applied for cancer surgery – when it’s just not possible to import bones from other parts of the body – cases requiring urgent medical attention won’t be utilising the use of 3D-printed implants anytime soon.
“At the moment, it’s only practical for cases where you have had a previous correction and something is still not right,” says Dr Mohd Nazimi.
The cost is another factor to consider – although the fees for a procedure involving 3D-printed technology is considerably lower today, compared to before, it can still add up to more than triple the cost of conventional surgery.
Even in government hospitals, the fees will have to be borne by the patient as there is yet to be a subsidy for the treatment.
Nevertheless, there are cost-cutting benefits to be seen in the long run, Dr Mohd Nazimi assures.
“The procedure may seem expensive at first, but if you opt for a conventional surgery and things go wrong, you will need another surgery. That’s not only extra cost, but also an additional risk for the patient, especially if he or she is an older patient,” he explains.
Recovery time can also be greatly reduced – in Sharifah’s case, her hospital stay only took five days as opposed to the norm of 10 to 14 days for a complex cranio-maxillofacial procedure.
Globally, the use of 3D-printed implants has met with varying degrees of success.
In 2012, a 3D-printed titanium implant was inserted into the jaw of an 83-year-old Belgian woman with oral cancer.
In 2013, surgeons at the University of Michigan, United States, saved the life of a three-month-old boy who had been born with severely weak tissue in his airway. A 3D-printed scaffold-like tube, designed to dissolve harmlessly after three years, was surgically implanted to hold his airway open.
Though we may possibly be half a century away from bio-printing organs, 3D printing is certainly revolutionising treatment options, Dr Mohd Nazimi says.
“The only challenge now is making it accessible to those who may not necessarily be able to afford it,” he adds.