Oct 19, 2015 | By Tess

Zimbabwean Blessing Makwera was only 15 years old when he was tragically injured by an exploding land mine. Fortunately he survived, but the blast left him disfigured, with severe damage done to his upper and lower jaws, his tongue, lips and teeth. Makwera lived for years without being able to properly use his jaw and mouth but at the age of 23 was discovered by Jennifer Trubenbach, the president of the California organization Operation of Hope, which offers surgical care and procedures to people in developing nations. Trubenback was leading a surgical mission in Zimbabwe when she found Makwera, and his positive disposition about his own life inspired her to help him.

Trubenbach explains of Blessing Makwera, “He has this contagious spirit that inspired all of us, despite his unfortunate circumstances. He never complains, he’s always grateful and finds the silver lining with everything in life.”

In order to provide Makwera with the necessary surgeries, Trubenbach enlisted the help of surgeons at Sharp Memorial Hospital in San Diego, California, including Dr. Joel Berger, a specialist in oral and maxillofacial surgeries. Dr. Berger, for his part, reached out to 3D Systems in order to help visually map out the surgical procedure necessary using their Virtual Surgical Planning (VSP) services.

It is not the first collaboration between Dr. Berger and 3D Systems. Mike Rensberger, who is in charge of 3D Systems’ VSP services explains, “We have worked with Dr. Berger to help pre-plan a wide range of surgeries. We’ve assisted with everything from corrective jaw surgery to maxillofacial trauma to fibula free flaps like Blessing’s case.”

The fibula free flap operation, which Makwera needed, consists of taking bone, tissue and vessels from the fibula and reconfiguring and structuring them to form jaw bones that are connected to blood vessels in the neck. The type of surgery was not unknown to Rensberger and his team at 3DS, as they had dealt with it before, but the time restrictions they were placed under was challenging as Makwera, who arrived in the U.S. on a Tuesday was scheduled for surgery on the Saturday.

Blessing Makwera before his surgeries

Rensberger received Makwera’s CT scans at 3DS’s healthcare facility in Colorado on Wednesday and got to work on creating a visual model of the surgery with the help of the Sharp Memorial team through a web meeting. In almost no time, the surgical plan was devised. Not only the plan, however, Rensberger and his team also 3D printed models and tools based on Makwera’s anatomy. The VSP team used 3D Systems ProX 800 and ProJet 7000 SLA 3D printers in order to additively manufacture the following:

  • Reconstructed mandible (lower jaw) model
  • Reconstructed maxilla (upper jaw) model
  • Mandible and fibula cutting tools to guide the surgeon’s blades

Notably, the ProX 800 was chosen for its ability to print in a wide range of materials as well as its surface smoothness, feature resolution, edge definition and tolerances, and the ProJet 7000 HD is often used for dental purposes, and offers materials that have tensile and impact strength resistant to high temperatures. Rensberger and his team also had to consider 3D printing in materials suitable for the operating room and that could be sterilized. In the end, two 3D Systems resin-based materials were selected: a transluscent material which allows for selective coloration of such details as tooth roots and nerve canals, and an opaque white material which was used for the cutting guides, templates, and post-operative models.

Rensberger and his team 3D printed two set of the mandible and maxillas, one to be used to pre-bend a titanium reconstruction plate to save time in the operating room, and one set to use as a reference during the actual operation. Because of Makwera’s unique anatomy, the models helped to familiarize the surgeons with the composition of his jaw before the operation. Fortunately, the surgical plan as well as additively manufactured models were completed in time and arrived to the hospital in San Diego by Friday, just in time for the surgery on Saturday.

Dr. Joel Berger of Sharp Memorial Hospital

The surgery took 12 hours to complete, but the result was a success as Blessing Makwera awoke to a new and functional jaw. 3D Systems also helped Makwera in a later surgery by providing the doctors with customized models for the pre-surgical planning of a procedure to implant supports for a dental prosthesis. The models helped not only the doctors to analyze bone volume and understand the anatomy of the patient, but also helped to restore Blessing Makwera’s optimistic smile.

Dr. Berger, who was in charge of Makwera’s surgery, wrote to 3D Systems in thanks saying, “The surgical planning and guides that you constructed allowed the two surgical teams to efficiently and quickly reconstruct the defects. The models, guides and templates were accurate, set very nicely, and allowed the surgery to go through without a hitch.”

As for Blessing Makwera, he is now a student at the College of Western Idaho and is all smiles, enjoying his newly reconstructed jaw and mouth.

Mike Rensberger of 3D Systems showing Blessing Makwera 3D printed models used in surgery



Posted in 3D Printing Application



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