The Download: Feature Articles
Using 3D Printed Models for Infant Cleft Palate Surgery Training
By Victoria Lubas | February 16, 2021
Dr. Pradip R. Shetye Leads a Course on Nasoalveolar Molding Appliances
From the classroom to the operating room, NYU Langone Health is leading the way in medical 3D printing, bettering lives while making technological strides. In recent years, Langone has partnered with Tandon's MakerSpace to 3D print orthotics for children with cerebral palsy and with the Lapidus Health Sciences Library to create adaptive occupational therapy tools and highly-detailed medical learning materials for nursing students. Most recently, Langone successfully completed the first successful face and double hand transplant, with the participation of NYU's LaGuardia Studio (LGS). Now, NYU Langone Health's Hansjörg Wyss Department of Plastic Surgery has collaborated again with the LGS to create realistic models of infant unilateral and bilateral cleft palates for the upcoming Nasoalveolar Molding Appliance Therapy hands-on workshop.
Repairing Cleft Lip and Palate
Cleft lip and palate¹ occur when the lip and palate tissues do not completely grow together during pregnancy, resulting in an opening on one or both sides of the lip or palate. This ailment is ultimately repaired through surgery within the first 12 months of life, but these surgeries are more streamlined when preceded by very early treatment with a Nasoalveolar Molding (NAM) appliance. Dr. Pradip R. Shetye, craniofacial orthodontist and the director of Langone's NAM Appliance hands-on workshop, explained that when babies with cleft lip and palate are just one-week-old, doctors fit them with customized NAM appliances that help gently mold babies' soft and hard tissues to begin "realigning the displaced lip, nose, [and] gum [three to four months] before surgery." NAM appliances are customized to each child and can be made conventionally in a dental laboratory or 3D printed at NYU Langone Health's Wyss Department of Plastic Surgery. Like braces, the appliances are worn 24 hours a day, including during feeding, and fit on the roof of the mouth similarly to a traditional removable retainer.² NAM appliances also have nasal stents that reshape the nose while preparing them for surgery.³
Dr. Shetye explained that NYU Wyss has "six to seven babies at any given time undergoing NAM treatment" while 49 percent of the American Cleft Palate-Craniofacial Association (ACPA)-approved cleft centers in the U.S. also offer NAM treatment.⁴ Training more health care providers will further increase the number of cleft teams in North America who can offer NAM therapy. Langone's NAM Appliance Therapy course will teach dentists, physicians, and other medical professionals every part of nasoalveolar molding therapy leading up to surgery—from making and fitting the customized appliances to making incremental adjustments through hands-on training with realistic 3D printed models. To create these learning models, Langone partnered with NYU's LaGuardia Studio (LGS) to produce highly-detailed, 3D printed models of infant faces with unilateral and bilateral cleft lip and palate.
Detailed 3D printed models enable surgeons to perfect their infant cleft palate surgery techniques. Photo courtesy of LaGuardia Studio.
Creating Lifelike Training Models
LGS created 16 unilateral and 16 bilateral cleft palate models in a process that took more than 48 continuous hours of printing. Printing several copies will allow each participant of the program to work on their own unilateral and bilateral model with individualized attention, ensuring a comprehensive training session. Previously, this sort of training was conducted on rigid, hand-made models that were less visually accurate and did not mimic feel or movement at all. The new LGS models are better proportioned and much more flexible than the previous models, allowing the 3D printed gums and tissues to bend and react more similarly to how a real tissue would.
Combining Langone's data with LaGuardia's selection of layering and printing materials resulted in a training experience that is much closer to real procedures. To create the prints, Shelly J. Smith, assistant director of NYU LaGuardia Studio, explained "We worked with Dr. Shetye...to develop and prototype the correct combination of [Stratasys] Vero and Agilus30 resin materials that delivered a flexible, realistic 'flesh-like' tactile feel, in addition to the correct coloring, level of infant mouth [and] gum detail, sizing and over print quality." These final infant models were created using the Stratasys J850 full-color PolyJet 3D printer. Dr. Shetye explained that the "original models Langone had were rigid like a statue, so these new flexible [models] are much more realistic and …[better] mimic how the tissues will respond to adjustments." In addition to the infant models, LGS also 3D printed dental impressions using the 3D Systems ProJet 7000 HD SLA printer and VisiJet SL Clear resin material, which allows for high-resolution, transparent 3D prints.
Looking Ahead
Originally scheduled for March 2020, the NAM Appliance Therapy course has been postponed due to the pandemic, but it is Dr. Shetye's hope that they will be able to run the course with social distancing and proper COVID procedures during the spring or summer 2021. The flexibility of the materials used to print the models means that one training session will not cause any permanent alterations, allowing the models to be used again for future courses.
Visit the NYU Langone website for more information regarding Langone's continuing medical education courses.
While the pandemic postponed these in-person courses, LGS has continued to aid the medical field with their 3D printing expertise, even printing PPE during lockdown. To commission LGS' 3D printing and scanning services for your own project, check out their website or email them at lgs@nyu.edu.