Home » News » A nose reconstructed identically thanks to a 3D mold entirely designed in the hospital

A nose reconstructed identically thanks to a 3D mold entirely designed in the hospital

On December 9, Dr Antoine Julienne, head of the reconstructive plastic surgery clinic at the Poitiers University Hospital, officiated at the Montmorillon Medico-Surgical Center. His “challenge of the day” was to reconstruct the nose of a patient, bitten by her dog. The problem is that the animal, decidedly playful, has swallowed the piece of nose that is missing, and with it, the cartilage that could have helped to reshape it.

A sample from the ear, “perfectly invisible”, makes it possible to recover the missing cartilage. Now you have to put it in shape, so that it looks like a nose …

“Usually we do a dozen tests. We model the cartilage, we put it in place, we remove it to modify it, we repeat a test, we remove it to reshape it, we try again, we remodify it…”. But this time, Dr Julienne came from Poitiers with a joker. The CHU had indeed a virtual image of the patient, produced during a CT scan, recently passed for a completely different pathology.

virtual nose modeling

virtual nose modeling

© Dr Antoine Julienne

“In fact, I extracted the data from the scanner, which I then used to model his old nose in 3D. It allowed me to make a negative mold, using a 3D printer.” Wrapped in a sterile film to be able to use it “live” in the operating room, this mold made it possible to position the cartilage taken from the ear. “I was thus able to reshape it, to identically recreate the missing nasal cartilage, which would constitute the structure of the reconstructed nose”.

It is a refinement of an existing surgical technique, which uses 3D printing to make it more precise. We used to do it a bit by eye, trying to look the other way to see how it was done. Whereas this is exactly the old nostril.

Dr Antoine Julienne, head of clinic in reconstructive plastic surgery

The trial and error which constituted a good part of the surgery operated in the operating room, are now carried out virtually, before. “It’s as if we were operating a little early, on our computer, quiet at home. We are going to do our surgery in the virtual world, to replay it in the real world via 3D printing.”

Video game software

Trained in nasal reconstruction by means of the virtual one, in Paris at the Tenon hospital, Dr Julienne was not necessarily a neophyte in the matter. As a teenager, his practice of video games had led him to invest in 3D modeling software, Blender, to create maps [des cartes] in Counter-Strike, a shooting game. It is therefore quite naturally with the help of this free software, which makes it possible at the same time to make animated film, architecture or content for video games, that the practitioner modeled the nose of his Montmorillon patient. “At the Poitiers CHU we have Solid Works, a software suite developed by Dassault, with which I would probably have achieved the same result, but it would have taken a lot longer because I don’t know how to use it “.

3D printing technology applied to medicine, although recent, is already in its infancy. 5% of French dentists are already equipped, and in Toulouse, an orthopedic surgeon is working on custom-made titanium hip prostheses, printed in 3D. But until now the implementation of this technology has been entrusted to prosthetists, therefore for commercial solutions.

The performance achieved by Dr Julienne is that this time, everything was done at the Poitiers University Hospital. “It is very rare for everything to be done in-house. The acquisition was carried out a few months ago on the hospital scanner, the computer-aided design, I did it myself, when printing the mold, I used the 3D printer from the anatomy laboratory “.

The cost of producing the mold is thus greatly reduced. Radically even, since it only costs 50 cents.

Benefits at all levels

But it is above all on the medical interest that Dr Julienne wishes to emphasize.

It increases surgical precision. Suddenly it reduces the intervention time and therefore the dose of anesthetic by the same amount. The potential complications are also reduced, thus making it possible to carry out the operation on an outpatient basis, whereas otherwise it would probably have been kept overnight in the hospital. There it is her son who took her in the morning, they operated on, and she left to be at home in the evening.

Dr Antoine Julienne, head of clinic in reconstructive plastic surgery

“Very excited about the technique”, the son has also expressed the wish to recover the digital file of his mother’s nose. “Since the medical data belong to the patient, I gave her the 3D file. I don’t know how he will use it, but it is possible that it will give rise to vocations.”

The use of 3D printing applied to medicine is developing rapidly and internal achievements should become widespread.

“It’s going quite quickly, and I think that in the near future we will probably be able to have tailor-made solutions developed internally in hospitals. There just need to be people like me who are a little motivated, to share their knowledge and raise awareness among the youngest who are often the most open to this kind of thing. Quite simply because they were born with a computer in their hands, and because for them 3D modeling and the use of objects in the virtual, it is much easier than for someone older “.

screenshot on Blender
screenshot on Blender

screenshot on Blender

© Dr Antoine Julienne

An awareness-raising project for young practitioners should normally see the light of day next year. The new surgical and probably anesthesia / resuscitation interns will thus be initiated as soon as they re-enter, just before taking up their duties. Training will allow them to get an idea of ​​the range of possibilities, so that they can grasp it and carry out research subjects on the subject if they wish.

The technologies exist, but the practical applications are still limited. Particularly because practitioners often do not have the necessary skills to take charge of the design part. However, this is often where the shoe pinches, because the design is made by engineers who have no hands in the sick. They will make a very nice cutting guide which will sometimes turn out to be too wide to fit into the incision. Other times it is the screwing angle which is not the right one. If it was a surgeon who had designed the part, he would have realized it and anticipated this sort of thing. It’s a bit of a difference between an architect and a mason.

Dr Antoine Julienne, head of clinic in reconstructive plastic surgery

It prefigures the medicine of tomorrow.

“We are moving more and more towards tailor-made. We see it in chemotherapy and immunotherapy: we characterize patients to offer them a medicine that is adapted to their person and not the same for everyone. as that is accompanied by an enormous reduction in health costs, these initiatives will be brought to generalize “.

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.