Application of computer aided simulation and three-dimensional printing in mandibular distraction osteogenesis for serious Pierre-Robin syndrome in infants

Abstract

Objective To establish a high-precision surgical approach for mandibular distraction osteogenesis (MDO) for treatment of serious Pierre-Robin syndrome (PRS) in infants. Methods Ten infants with serious PRS were enrolled in this study. Before the operation, osteotomy and distraction were simulated using computer software, followed by three-dimensional (3D) printing of the head model for verifying the simulation results. After the verification, the individualized osteotomy template and bended distractor were constructed using a 3D printer to assist in subsequent osteotomy and fixation of the distractor. Five days after the operation, the distraction started at a daily rate of 1.2 mm until mild anterior crossbite occurred. The operative time, blood loss, distracted length, postoperative tracheal intubation time, and improvement of eating behavior after the operation were recorded. After the distraction, all the infants underwent CT examination for measurement of the distance from the tongue root to the posterior pharyngeal wall; they also received polysomnogram (PSG) examination to determine the apnea hyponea index (AHI). The distractors were removed surgically at 3 months after the operation. Results The operations were completed successfully in all the 10 infants. The mean operative time of the first operation was 1.72±0.15 h with a mean blood loss of 16±3 mL; the mandibular distraction distance on 20 sides averaged 11.11±1.18 mm. The postoperative endotracheal intubation time was 6.10±0.74 d. After the extubation, 8 infants started oral feeding, and their daily milk intake reached 374.0±65.2 mL 7 d later while the other 2 infants still required nasal feeding. After the distraction, the mean distance from the tongue root to the posterior pharyngeal wall was 7.17±0.70 mm. PSG showed AHI of 1.5±0.6 in these infants. All the infants had good osteogenesis in the distraction area without symptoms of facial nerve injury and showed significant improvement in the lower part of the face. Conclusion For infants with serious PRS, computer aided simulation combined with 3D printing for guiding osteotomy and distraction not only improves the surgical precision of MDO and shortens the operative time, but also avoids damages to important anatomical structures during the surgery.

Keywords

• computer aided simulation
• 3d printing
• mandibular distraction orthogenesis
• pierre-robin syndrome
• infants