Application of low-cost fused deposition modeling additive manufacturing rapid anatomic models in patients with rhino-cerebral mucormycosis treated with maxillectomy
Mucormycosis is a fungal infection mainly of immunocompromised patients. It has many clinical manifestations depending on the system that is affected. Rhinocerebral mucormycosis and pulmonary infection are the most common. In this pathology, the fungi invade the endothelium of the blood vessels with partial or total obliteration, with tissue ischemia and necrosis. The initial symptoms are unspecific making difficult to identify from other infections and need an expert suspicion level. The gold standard is the culture of the fungi; histopathology analysis shows empty hyphae with thin walls. Combined treatment is strongly recommended surgical extended debridement and Amphotericin B is the gold standard of treatment. The craniofacial skeleton (CS) has a very peculiar bone and soft tissue distribution that maintains height, width, and projection. In RCM, aggressive debridement is prognostic for patient survival. Extensive maxillectomies, often with orbital exenteration represent a reconstructive challenge for plastic surgeons. Recently different types of additive manufacture (AM) technology had been proposed in surgical planning. Fused deposition manufacture (FDM) technology could be the most cost-effective for patients. To the best of our knowledge, this is the first report of the use of FDM and reconstruction of patients with RCM. RCM is a very serious life-threatening condition. When treated in time with the adequate surgical approach and a correct antifungal medicine RCM can be a cured. The goals in treating this condition are very clear. A free flap reconstruction is an adequate approach to patients with RCM and FDM RAM can help the surgeon to plan the free flap in site. We present two cases reconstructed with MSAP and ALT-FL respectively with success assisted with FDM RAM.
Level of Evidence: Level V, therapeutic study.
Keywords3D printing Rhinocerebral mucormycosis Rapid prototyping Free flap
Compliance with ethical standards
We received no funding from the government nor private organizations.
Conflict of interests
Marco Aurelio Rendón-Medina and Erik Hanson-Viana declare that they have no conflict of interest.
The protocol was approved by the ethical committee of the Hospital Regional de Alta Especialidad de Ixtapaluca.
Patients provided verbal and written consent beofre their inclusion in this study.
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