Abstract
Objective
Patient-specific implants (PSI) for cranioplasty are expensive, and cost remains the limiting factor in low- to middle-income countries. The authors describe a novel, reproducible and cost-effective method of designing prefabricated titanium PSI cranioplasty.
Methods
Ten patients from June 2018 to December 2020 were included in this retrospective study. A three-dimensional stereolithography model was made on a custom-built 3D printer with variable layer heights to produce efficient and accurate details. A certain amount of defect in the temporal region was left uncovered to avoid complications related to temporalis muscle dissection. The stereolithography model with a cranial defect was reconstructed with modelling wax. The wax model was scanned with a blue light visible scanner. The digital data was transferred to the milling machine (Jayon Surgical®, Kerala, India), where a 1-mm-thick sheet of titanium was milled according to the specifications. RFCC scoring system was used for assessing cosmetic outcome.
Results
The mean duration of the surgery was 56.50 min, SD = 14.916 min (range 45–75 min). In 9/10 patients, the RFCC score was 4 points. No other complications were found at a minimum follow-up of 18 months in all patients. The cost per patient was approximately 30,000 INR or 400 US dollars. The average time required for us to get the PSI ready for surgery was about 15 days.
Conclusion
The authors demonstrate a novel, cost-effective and reproducible method of PSI using titanium for cranioplasty.
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Acknowledgements
The authors thank Dr R.N Sahu (Prof. and Head), Department of Neurosurgery AIIMS, Bhubaneswar, India, for their constant pursuance and guidance during this study, Mr Nachiketha, design head from Osteo3d®, Bangalore, India, for his considerable work in computer-aided designing.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Dash, C., Dasukil, S., Boyina, K.K. et al. A novel prefabricated patient-specific titanium cranioplasty: reconsideration from a traditional approach. Oral Maxillofac Surg 26, 223–228 (2022). https://doi.org/10.1007/s10006-021-00977-5
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DOI: https://doi.org/10.1007/s10006-021-00977-5