Aug. 14, 2024
When conditions such as cancer, trauma or complications from previous surgery affect the eyes, as well as surrounding facial structures, patients can benefit from a multidisciplinary approach. The Mayo Clinic Oculofacial Plastics Clinic (OFPC) in Rochester, Minnesota, streamlines evaluation and treatment for people with complex periorbital reconstructive needs.
Patients are evaluated by multiple specialists and receive any needed advanced testing, such as high-resolution CT scans for creation of 3D-printed models. Often, this can all be coordinated within a single day. A team of doctors reviews all clinical information and imaging and develops a treatment plan tailored to each patient's exact needs. After the multidisciplinary team develops a treatment plan, patients meet again with the team and discuss options for medical or surgical treatment.
"The OFPC is led by a plastic surgeon and an oculoplastic surgeon," says Lilly H. Wagner, M.D., an ophthalmologist and co-director of the Oculofacial Plastics Clinic at Mayo Clinic in Rochester, Minnesota. "If needed, other specialists are available for consultation, including dermatologists, head and neck surgeons, strabismus surgeons, and neurosurgeons."
"Any trauma with orbital involvement requires a comprehensive evaluation," says Basel A. Sharaf, M.D., D.D.S., a plastic and reconstructive surgeon and co-director of the Oculofacial Plastics Clinic. "Our collaborative effort with ophthalmology and oculoplastic surgery has been tremendously beneficial for our patients and for our teams."
In addition to the collaboration among specialties, the OFPC team works closely with specialized radiologists who create patient-specific 3D-printed models to support surgical planning. The integrated team helps solve complex surgical problems that arise during evaluation and treatment. This allows engineering, 3D printing and custom medical device manufacturing experts and surgical experts to work together.
"We started doing 3D printing about 17 years ago at Mayo Clinic, and it's expanded over that time frame to encompass every surgical subspecialty," says Jonathan M. Morris, M.D., medical director of the 3D Anatomic Modeling Unit at Mayo Clinic in Rochester, Minnesota. "The reason it started in-house is because we have subspecialty expertise in each part of the process. We had these complex problems, and we found that 3D printing aided in understanding them in a three-dimensional, life-size way that two-dimensional images could not."
Having the capability of in-house 3D printing reduces the amount of turnaround time needed. "Working in-house allows us to create things quickly — sometimes within 3 to 4 hours," explains Dr. Morris. "The time it takes depends on the materials used and the complexity of the need, of course, but in general we can deliver something within a week or so. Working with a third-party company can take multiple weeks or months from start to finish."
"It is incredibly helpful when physicians and surgeons are able to have the life-size 3D model in their hands," says Dr. Wagner. "We can visualize where a tumor or injury is exactly located within the anatomy that's usually covered up by soft tissue. Measurements can be made right on the model, and we can better understand what adjacent critical structures are nearby and what is the best approach to minimize the overall impact to the patient."
The team also specializes in making custom 3D-printed patient-specific devices. "For example, if we have to cut a patient's bone in a certain direction or trajectory," explains Dr. Morris. "Then we take the patient's imaging, create a 3D model of that patient's skull or orbital socket or jaw or maxilla, and then do all of the cutting of the bones on a computer program. This is referred to as virtual surgical planning."
"Then we can actually '3D print' a sterilizable jig, for lack of a better word, that screws on to the bone," continues Dr. Morris. "And then, it guides a saw or a drill to a specific location in a very controlled manner, which allows us to do several things in the head and neck but also around the orbits."
Aside from anatomic models for surgical planning, the 3D unit also creates bespoke items for patients such as prosthetics, hand braces, and custom devices or appliances that aren't currently available in the marketplace. In addition to these applications, educational simulations can be created as new procedures become available.
"We also create training applications, cutting simulations and custom training modules," says Dr. Morris. "For example, there was a new procedure in skull-based neurosurgery where we used 3D printing and silicone molding to create an entire training apparatus to be able to teach people how to put needles in and around the muscles that control the eye while the patient is essentially awake or asleep."
The combination of the multidisciplinary approach of the Oculofacial Plastics Clinic and the expertise of the 3D-printing team makes Mayo Clinic's resources and capabilities especially unique. "We are always looking for new or different ways to approach and solve problems, and having diverse perspectives is essential," says Dr. Wagner. When our teams combine as a whole, we're able to solve many complex problems in innovative ways."
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