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Development and Validation of a 3D Printed Mandible Model for Surgical Simulation
Katherine J. Zhu, BS
1; Jacob Hammond
2; Stone Meng
3; Jesse Haworth, MSE
2; Andy S. Ding, MD, MSE
4; Kristen Pan, MD
1; Jordan Gornitsky, MD
1; Edgar Soto, MD
1; Russell H. Taylor, PhD
5;Robin Yang, MD, DDS
1
1. Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine,
Baltimore, MD 2. Department of Mechanical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 3Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD 4. Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, 5. Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, MD
Background Mandibular bilateral sagittal split osteotomy (BSSO) is a common procedure used in orthognathic surgery. The greatest risk of BSSO is damage to the inferior alveolar nerve, resulting in facial numbness and poor quality of life. A lack of surgical experience is associated with a higher risk of complications, and as a result, BSSO surgical training is critical. Existing training tools, such as cadavers and anatomical models, may be expensive, limit options for repeated practice, and lack patient-specificity. We aimed to create a low-cost, biomechanically accurate mandibular model for surgical training to prevent such complications.
Methods A virtual three-dimensional (3D) model of a human mandible was segmented from computed tomography scans and printed using nine different resin mixtures. Two residents and two attending surgeons performed user testing to determine which resin mixture had the most realistic haptic feedback. Biomechanical properties, such as tensile strength, yield strength, and Young's modulus were calculated for each resin mixture. After identifying the preferred resin mixture, we conducted mock-operative tests to compare the force required to cut through our 3D printed model, a human cadaveric mandible, and a commercially available model.
Results A mix of 45% Anycubic Colored Ultraviolet Resin and 55% Siraya Tech Tenacious was found to best mimic human bone. Surgeons reported feeling an accurate proprioceptive transition between cancellous and cortical bone. The osteotomy force profiles were similar across our 3D printed (2.8±1.7 N), cadaveric (2.6±1.6 N), and commercial (2.9±1.8 N) mandibles. For maximum cut force, our model (5.6 N) closely resembled the cadaveric mandible (5.3 N) compared to the commercially available model (6.3 N). The total cost per 3D printed mandible was $2.48.
Discussion We developed and validated a low-cost method for 3D printed patient-specific mandibular models for BSSO surgical simulation. Future directions include evaluating these models for surgical training to prevent complications.
Figure 1. Osteotomy Force Profiles of the Three Types of Mandibles for Surgical Practice
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