Aide from Afar

Blessings Makwera suffered horrific facial injuries over 14 years ago in Zimbabwe, when he was just 9 years old. A land-mine detonator exploded in Makwera’s mouth, causing an incredible amount of damage to his mouth, lips, tongue, teeth and jaw. Jennifer Trubenbach, the President of Operation Hope, located in California, discovered Makwera in his native country of Zimbabwe during a surgical mission. Operation Hope was founded to provide life-changing surgeries to the less-fortunate people across the world. Once Trubenbach met Blessing and heard his story, she was moved to help him. She brought his story back to the United States with hopes of find a way to changr his life forever – just this time in a positive way. Blessing would spend the next 2 years of his life waiting while across the world at the Sharp Memorial Hospital in San Diego, California, Dr. Joel Berger, who specializing in oral and maxillofacial surgery, and his team of surgeons worked to find a way to provide a man they didn’t know, a new face.

Blessing Makwera before his maxillofacial and dental surgeries aided by 3D printing.

When asked about Blessing Makwera, Trubenbach was quick to provide:

“He has this contagious spirit that inspired all of us, despite his unfortunate circumstances. He never complains, he’s always grateful and finds the silver lining with everything in life.”

In order to make this possible, Dr. Berger would utilize some of the most revolutionary technologies in the medical industry to date. Hence, he reached out to 3D Systems in need of cutting-edge Virtual Surgical Planning (VSP) services.

“We have worked with Dr. Berger to help pre-plan a wide range of surgeries,” says Mike Rensberger, who spearheads 3D Systems’ VSP Reconstruction services, part of the company’s 3D healthcare offerings. “We’ve assisted with everything from corrective jaw surgery to maxillofacial trauma to fibula free flaps like Blessing’s case.”

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The Planning Process

Once Blessing was in their hands, the hospital team, led by Dr. Berger and plastic surgeon a Dr. James Chao, Rensberger and his 3D Systems team, undertook an extremely delicate planning process for the 12-hour surgery they would eventually conduct on Makwera. Blessing arrived just 4 days prior to his scheduled surgery which really put them on a tight schedule. The upper and lower jaw surgery forced them all to work hand in hand in order to develop an appropriate surgical plan.

The operation, known as a fibula free flap, requires removing bone, tissue and vessels from the patients fibula and reconstructing them in order to form new upper and lower jaws which connect to blood vessels in the neck. Rensberger and his team had experience with the procedure, but the time frame was extremely small and demanding. Because of this, Blessing’s CT scans were sent to 3D System’s healthcare services facilities, located in Golden, CO, just 3 days prior to the surgery. Upon their arrival, 3D anatomical information was taken out of them bu 3D Systems’ engineering in order to create 3D visualization.

2 hours after their arrival, the 3D Systems team was collaborating with the team at Sharp Memorial via webcast, creating a surgical plan for his surgery. After finishing the surgical plan in just an hour, Rensberger provided:

“I was running the surgical planning software on my computer in our offices in Golden while surgeons viewed my computer screen and directed the cuts and movements from a conference room in San Diego — all in real-time 3D.”

A 3D model that was used for reference during the operation. The 3D Systems material used in these models allow for selective coloration, showing surgeons what is hidden beneath layers of soft and hard tissue.

3D Printing Provides Help

Aside from the 3D surgical plans, 3D Systems provided help by using their Stereolithography (SLA) 3D Printers to produce different models and tools based off of Makwera’s anatomy. SLA printers transform liquid raw material into solids through the use of light. Because SLA prints don’t normally need struts or supports, these printers have various advantages in terms of accuracy, efficiency and the capability to produce complex objects in a single pass. The problem with them is that the choice of materials is very limited. They are ordinarily exotic liquid polymers, and can’t be used to print metal or chocolate.

The team elected to use the ProJet 7000 HD 3D printer, which provide users with incredibly high part quality and accuracy. Using Stereolithography (SLA) technology, the ProJet 7000 printers are capable of printing single, large-sized or multiple small-sized parts and prototypes. The simple workflow of the printers allow for any user to conduct 3D prints. ProJet 7000 3D printers can also produce end-use parts and prototypes up to 4 times faster than competing 3D printers.

Makwera’s surgery required 3 different sets of models and tools:

  • A reconstructed mandible (lower jaw) model with a matching plate-bending template, plus a reconstructed maxilla (upper jaw) model. These were used by surgeons to pre-bend a titanium reconstruction plate prior to surgery, saving valuable operation time.
  • Mandible and fibula cutting tools to guide the surgeon’s saw blades in the operating room.
  • Mandible and maxilla models used for reference during the operation. These models show surgeons what is hidden beneath layers of soft tissues. They gave surgeons hands-on experience with Blessing’s jaw anatomy before starting surgery.

[Credit: 3D Systems]

Rensberger and his team elected to use two materials exclusive to 3D Systems 3D printers: one of translucent appearance which allowed them to color select tooth roots and nerve canals, and the other a white, opaque material that was used for the 3D printing cutting guides, templates and post-operation models because of its high quality properties. According to Rensberger:

“Since Blessing lacked normal anatomy to refer to while designing the reconstruction, a set of normalized anatomy was used to help with sizing and shaping the fibula free flap segments to give him a normal appearance.”

The following afternoon, 2 days before his surgery, the 3D printed surgical guides were finished and overnight shipped to Sharp Memorial Hospital. Upon their arrival on the eve of the surgery (Friday), the surgical team closely reviewed each model, template and guide. Their conclusion: 3D printing had successfully provided them with accurate aides that were ready to be used in Blessing’s surgery the next day.

Blessing Makwera smiles while holding the reconstructed model created by 3D Systems for his fibula free flap operation.

A New Smile

That Saturday, Dr. Berger and his team successfully completed the 12-hour surgery on Blessing. He now had a jaw which looked and performed just as a normal one would. Later on, Blessing also received implants within his new jaw which provided dental prosthesis support, allowing for him to smile again. Once again, 3D systems provided the models specific to Blessing’s anatomy that were used in pre-surgical planning. The models were constructed using a variety of material which allow for analysis on Blessing’s jawbone volume, understanding of Blessing’s closeby anatomical landmarks and aide in easy prepping for future oral-maxillofacial surgeries.

Today, Blessing Makwera can be found smiling and laughing his way around the College of Western Idaho campus where he attends classes. In his spare time, Blessing fixes motorcycles from spare parts found in junkyards. This was all possible thanks to the dedicated support and work of Operation Hope, Sharp Memorial Hospital and 3D Systems. When asked to summarize the benefits of 3D printing technology in surgical aide, Dr. Berger stated:

“The surgical planning and guides that you constructed allowed the two surgical teams to efficiently and quickly reconstruct the defects. The models, guides and templates were accurate, set very nicely, and allowed the surgery to go through without a hitch.”

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