title: Reconstruction of an Extensive Midfacial Defect Using Additive Manufacturing Techniques.
abstract: Malignant peripheral nerve sheath tumors are extremely rare tumors arising in peripheral nerves. Only 17 cases involving the trigeminal nerve have ever been reported. These tumors have a very poor prognosis and very high rates of recurrence and metastases. Their recommended treatment involves complete tumor resection followed by radiation. This can be problematic in the head and neck region. We present a clinical case involving a 33-year-old female patient presenting with a slow-growing, exophytic mass of the anterior maxilla. Incisional biopsy and subsequent histological examination revealed a diagnosis of a malignant peripheral nerve sheath tumor. Surgical resection involved a complete maxillectomy, rhinectomy, and resection of the upper lip and aspects of the left and right cheeks. Reconstruction of the subsequent defect incorporated the placement of four zygomatic oncology implants to aid in retention of a facial prosthesis. These implants, however, were subsequently lost; and an anatomical model of the hard tissues was manufactured via 3D printing. This model was used to design and manufacture a titanium frame (customized implant) for the patient. The frame was then fixated and secured intraoperatively with 21 cortical screws. A maxillary denture and silicone facial prosthesis were also made to fit onto this frame. This is the first known case where additive manufacturing, via the use of rapid prototyping and 3D printing, was employed to manufacture a facial prosthesis.
authors.affiliation: Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa. nelsondentist@gmail.com.
authors.forename: Nelson
authors.initials: N
authors.lastname: Fernandes
authors.affiliation: Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa.
authors.forename: Jacobus
authors.initials: J
authors.lastname: van den Heever
authors.affiliation: Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa.
authors.forename: Christiaan
authors.initials: C
authors.lastname: Hoogendijk
authors.affiliation: Department of Maxillofacial and Oral Surgery, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa.
authors.forename: Sarel
authors.initials: S
authors.lastname: Botha
authors.affiliation: Centre of Rapid Prototyping and Manufacturing, Central University of Technology, Bloemfontein, South Africa.
authors.forename: Gerrie
authors.initials: G
authors.lastname: Booysen
authors.affiliation: Centre of Rapid Prototyping and Manufacturing, Central University of Technology, Bloemfontein, South Africa.
authors.forename: Johan
authors.initials: J
authors.lastname: Els
mesh_terms: D000328:Adult; D002610:Cheek; D005260:Female; D006801:Humans; D008046:Lip / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D008953:Models, Anatomic; D018317:Nerve Sheath Neoplasms / Q000601:surgery*; D066330:Printing, Three-Dimensional; D011474:Prosthesis Design
keywords: 3D printing; Rapid prototyping; facial prosthesis; malignant peripheral nerve sheath tumors