Perfecting the Profile: 3D Printed Surgical Guides in Obtaining Ideal Nasal Contour in Rhinoplasty
Jillian S. Schreiber, MD, Alexandra R. Gordon, BA, Oren M. Tepper, MD.
Montefiore Medical Center, bronx, NY, USA.
Introduction: Virtual simulation is becoming increasingly common during rhinoplasty consultation. This virtual plan, however, is currently limited to pre-operative visualization. This study aims to translate the virtual rhinoplasty simulation into an operative plan by using 3D printing. We evaluate the application of 3D-printed surgical guides to determine nasal tip position and dorsal height during rhinoplasty.
Methods: Virtual simulations of the ideal aesthetic result were created during pre-operative consultation. Profile surgical guides based on the simulated result were created using 3D printing (n=17). The 3D printed profile guides were printed and sterilized for intra-operative use. 3D printed guides were fit onto the nose at the midline to assess profile nasal contour prior to tip modification and following each maneuver to visualize the dorsal height and the nasal tip projection and rotation relative to the simulated result (Figure 1). On-table post-operative 3D photographs were compared to the pre-operative simulation to objectively measure adherence to the surgical plan.
Results: 3D printed guides based on the rhinoplasty simulation resulted in adherence to the surgical plan in all cases. The simulated nasal tip position was achieved within 1.2±1.3mm for projection and 0.5±0.7mm for rotation. Projection for the simulated cartilaginous and bony dorsum was within 0.9±0.8 and 1.1±0.9mm respectively. Nasal guides, printed based on the pre-operative simulation, objectively define the intended profile contour, allowing for quantifiable changes to approach the simulated ideal result.
Conclusion: 3D printed surgical guides provide a method for translating the virtual simulation into an operative plan. The aesthetic goals defined pre-operatively are successfully achieved by way of 3D printed profile nasal guides. In addition, this technology offers a novel medium for true anatomic reference that is superior to traditional 2D photographs. With the increasing use virtual simulation in rhinoplasty consultation, 3D printed guides assist in achieving the aesthetic goals that are determined preoperatively.
Figure 1: Use of Nasal Guide Intraoperatively. (a) demonstrates the over-rotated nasal tip that must be corrected and the ceramic model of the preoperative image. (b) shows the nasal guide on the nose after tip derotation. 
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