patient-specific manufactured implants may be superior for orbital reconstruction (orbital volume difference p= 0:029) [56]. Hence, improvement in outcomes seems to be related with the degree of customization of the implant. Furthermore, 3DP proves to be of use in congenital surgery. Le Fort osteotomies and monobloc frontofacial advancement surgery benefit from a combination of virtual planning and surgical guides. Computer-assisted surgery is particularly useful for management of complex cranial malformations such as plagiocephaly, oxycephaly, hypertelorism, Crouzon disease, and Treacher Collins syndrome [57, 58]. Moreover, these types of surgeries can be performed in combination with orthognathic surgery and temporomandibular joint reconstruction. 3DP is having a deep impact in these procedures as orthognathic surgery was at the forefront of virtual planning development, and TMJ reconstruction surgery was an early adopter of custommade prosthesis [59, 60]. Head and neck surgery also benefit from rapid AM [53]. The most common application is related with bone resection and reconstruction during oncologic surgery. In these cases, fibular flaps can be virtually designed, and guides can be printed to increase precision and reduce surgical time [61, 62]. In addition, dental rehabilitation can be performed simultaneously with dental implants [62]. Furthermore, 3DP can have a special impact in education. Although in its early stages, positive interventions have been published for teaching head and neck anatomy at undergraduate and graduate level [63, 64], thus, increasing anatomical understanding and reducing dependency on cadaveric workshops. Cost-effectiveness of 3DP in various areas of medicine is yet to be assessed. However, maxillofacial surgery is at the forefront in the validation of this technology under several clinical trials [18]. For instance, Ayoub et al. concluded in a 2014 clinical trial that CAD surgery significantly shortened the time of transplant ischemia and defect reconstruction [65]. Dumas et al. described manufacturing costs for a 3Dprinted skull model of $200 (labor cost included) with a turnaround time of 24 hours [66]. These papers advocate for the economic feasibility of 3DP [67]. Future prospects in head and neck reconstructive surgery are paired with tissue engineering and bioprinting. Recent studies have shown how novel biomaterials and polymeric 3DP may aid in the management of congenital pathologies like microtia or alveolar cleft and in acquired tissue defects [68, 69]. In conclusion, rapid AM is reshaping craniofacial and head and neck surgery. It is an efficient solution that improves surgical outcomes and reduces surgical time, especially in pathologies that require fine 3D conformation. 3.1.2. Brain and Spinal Cord. 3DP is developing at a rapid pace with countless biomedical applications especially in highly demanding, precise, and technological fields such as neurosurgery. 3DP technologies obviate the need to learn on the patient. This section provides a brief overview of the current state-of-the-art of 3DP applications in neurosurgery focusing on three general areas: (a) creation of 3Dprinted patient-specific anatomical and pathological models; (b) creation of 3D-printed neurosurgical instruments, devices, and implants; and (c) creation of 3D bioprinted scaffolding for tissue engineering and research. The creation of patient-specific models is perhaps the most impactful application of 3DP technologies and has shown to enhance presurgical planning, surgical simulation with recreation of surgical scenarios and complications (e.g., intraoperative dural sinus injury), surgical training, patient education, and interdisciplinary communication R S: –141.548mm 1 B: 3: HUESO 6.625 mm B: 3: HUESO 0.625 mm B: 3: HUESO 0.625 mm Y R: –12.188mm G A: 57.337mm Figure 1: Computerized tomography (CT) of coronal, transverse, and sagittal planes that shows the orbital floor fracture. 3D-printed CT model is shown with the appropriate mesh, and this technique is used to provide a better approach in the treatment of skull fractures. Used with permission from the author Dr. Javier Asensio-Salazar. 4 BioMed Research International | The Surgical Technologist | JUNE 2022 256
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