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Original Investigation
January 5, 2017

Benefits and Limitations of Entry-Level 3-Dimensional Printing of Maxillofacial Skeletal Models

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Tufts University School of Medicine, Boston, Massachusetts
  • 2Department of Information Technology Services, Tufts Medical Center, Boston, Massachusetts
  • 3Division of Pediatric Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Floating Hospital for Children–Tufts Medical Center, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. Published online January 5, 2017. doi:10.1001/jamaoto.2016.3673
Key Points

Question  Can an in-house, entry-level 3-dimensional printed model serve as an alternative to high-end commercial products and be justified financially and clinically?

Results  This case series found that entry-level, in-house production was comparable to high-end vendor modeling for surface anatomy and physical resilience, superior for cost and speed of production, variable for nerve canal visibility, and inferior for sterilizability, virtual surgical planning options, and tooth root visibility.

Meaning  For purposes of uncomplicated surgical planning, education, and plate bending, in-house entry-level 3-dimensional printing is achievable with minimal training and at a significantly reduced cost compared with vendor products, which may easily justify its use in an otolaryngologic practice.

Abstract

Importance  A protocol for creating exceptionally low-cost 3-dimensional (3-D) maxillofacial skeletal models does not require proficiency with computer software or intensive labor. Small and less affluent centers can produce models with little loss in accuracy and clinical utility.

Objectives  To highlight the feasibility and methods of introducing in-house, entry-level additive manufacturing (3-D printing) technology to otolaryngologic craniofacial reconstruction and to describe its clinical applications and limitations, including a comparison with available vendor models.

Design, Setting, and Participants  This case series of 6 models (3 pairs) compared cost, side-by-side anatomical model fidelity, and clinical versatility using entry-level, in-house 3-D pediatric mandible model production vs high-end, third-party vendor modeling, including a review of the literature. Comparisons were made at an urban pediatric otolaryngology practice among patients who had previously undergone pediatric craniofacial reconstruction with use of a commercially produced medical model for surgical planning. Each vendor model had been produced using computed tomographic imaging data. With the use of this same data source, in-house models were printed in polylactic acid using a commercially available printer. Data were collected from November 1 to December 30, 2015.

Main Outcomes and Measures  Models created from these 2 methods of production were assessed for fidelity of surface anatomy, resilience to manipulation and plate bending, cost of production, speed of production, sterilizability, virtual surgical planning options, and alveolar nerve canal and tooth root visibility in mandibles.

Results  For the quantitative comparisons between in-house models (1 neonatal, 1 pediatric, and 1 adult model) and their commercial counterparts, the mean value of 7 independent measurements was analyzed from each of 3 model pairs. Caliper measurements from models produced through entry-level, in-house manufacturing were comparable to those taken from commercially produced counterparts, suggesting an acceptable degree of accuracy (0.54 mm; 95% CI, 0.36-0.72 mm). Fixed costs for in-house production included acquiring an entry-level printer (retail $2899) and an annual software subscription ($699 per year). After purchase of these initial assets, the printing cost for an in-house mandible was approximately $90, with 98% of that cost related to labor. Physical qualities of entry-level, in-house models such as nerve canal visibility, tooth root visibility, and sterilizability were inferior compared with commercially-produced stereolithic renderings.

Conclusions and Relevance  This low-cost method of in-house, entry-level 3-D printing of straightforward, skeletal models may suit a general otolaryngology practice that performs maxillofacial reconstruction. Although commercial modeling offers several unique features, such as sterilizable materials and advanced virtual planning, in-house modeling also produces renderings with high fidelity, which may be used as tools for education and surgical planning, including preoperative plate bending.

Level of Evidence  4.

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