The pediatric maxillofacial surgery team at the SJD Barcelona Children’s Hospital (SJD) recently completed a complicated operation to resect a malignant tumor in an 11-year-old boy named André.
The story tells that André was diagnosed with retinoblastoma when he was 11 months old. When his parents decided to have him treated at SJD Barcelona Children’s Hospital in 2016, the medical team decided to change his prosthesis in his right eyeball.
After two years of treatment to treat the first tumor, he recovered with a specific treatment. However, as Andrés was a carrier of a germline gene, the doctors told his parents that the boy could suffer a type of cancer in his bone system, something that happened years later when he developed a facial osteosarcoma.
The treatment plan of the oncology team was to carry out chemotherapy for three months; thereafter, a fundamental part of the treatment aimed to guarantee local control of the lesion. For this, it is essential to obtain a complete section of the tumor, other local treatments such as radiotherapy in this type of tumor are not as effective and, in addition, this patient had already had a radio induced tumor.
Given the complexity of the operation, the medical team led by Dr. Josep Rubio, head of the maxillofacial surgery unit at SJD Barcelona Children’s Hospital, decided to carry out preoperative planning and simulation using 3D printed anatomical models of the parts of the patient’s skull.
The planning consisted of the 3D design of the anatomy of the limits of the resection to be performed in the subsequent intervention, creating an image of the skull and the patient’s child’s tumor, which was then 3D printed in the hospital’s 3D printing laboratory.
The medical team and the radiologists 3D printed both pieces using BCN3D’s 3D printing technology – specifically the W27 3D printer from the Epsilon series – which, with its double extruder head and the materials used (ABS), provides the necessary realism for the doctors to plan the actual surgical intervention based on the exact resection of the entirety of the child’s eye tumor, a facial osteosarcoma.
Biomodels serve as a visual aid, portraying the anatomical relationships and the relationship of the tumor with the different anatomical parts. They function as a pre-surgical simulation model, aiding the practice of the cuts to be made by the surgeon. That being said, it should be noted that the team of the SJD Barcelona Children’s Hospital 3D planning unit has open lines of research to improve the printed models and achieve, through research into mechanical properties, colours, and textures, a better imitation of living tissues.
“The goal of the surgery was to remove a child’s tumor located in his cheekbone and to remove the tumor with safe margins. To do this we used 3D planning to delimit the limits of the resection. Nowadays, 3D planning at the SJD Barcelona Children’s Hospital is standard practice in maxillofacial surgery, especially in very complex cases such as the one we dealt with in this child. We had to create cutting and positioning guides to transfer the virtual planning from the computer to the operating theatre. This has allowed us to execute what we designed virtually with precision to be able to extract the safety margins next to the tumor as previously designed,” explains Dr. Josep Rubio, head of the maxillofacial surgery unit at SJD Barcelona Children’s Hospital.
3D printing technology helped to plan the operation and accurately delineate the tumor in the cheekbone eye.
“3D printing helped us avoid potential postoperative complications and improved the quality for both the patient and the surgical process. After weeks of surgical planning, we were able to perform a complete resection of the lesion and also preserve the patient’s vision,” says Dr Adaia Valls, maxillofacial surgeon at SJD Barcelona Children’s Hospital.
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