Onerci Altunay Zeynep, Bly Joseph A, Edwards Philip K, Holmes David R, Hamilton Grant S, O'Brien Erin K, Carr Alan B, Camp Jon J, Stokken Janalee K, Pallanch John F
Department of Otorhinolaryngology, Acibadem University, Istanbul, Turkey.
Am J Rhinol Allergy. 2016 Jul;30(4):287-93. doi: 10.2500/ajra.2016.30.4324.
Since 1972, patients with large nasal perforations, who were symptomatic, and who were not candidates for surgery, had the option of custom prosthetic closure at Mayo Clinic. Although septal prostheses have helped many patients, 27% of pre-1982 patients chose not to keep the prosthesis in place. Two-dimensional computed tomography (CT) sizing resulted in more of the patients choosing to retain the prosthesis. The introduction of three-dimensional (3-D) printing to the sizing process offered the potential of further improved retention by refinement in prosthesis fit.
To describe the fabrication of nasal septal prostheses by using 3-D printing for sizing and to compare the retention rate of 3-D-sized prostheses with those that used previous sizing methods.
Twenty-one consecutive patients who had placement of septal prostheses sized by using 3-D printed templates were studied. CT image data were used to print 3-D templates of the exact shape of the patient's septal perforation, and medical-grade silastic prostheses were fabricated to fit. In four cases, the 3-D printed template allowed preoperative surgical simulation. Metrics collected included prosthesis retention; symptoms, including intranasal crusting and epistaxis; and previous prosthetic closure failures.
Twenty of the twenty-one patients had improvement in symptoms. The mean diameter of the perforations was 2.4 cm; the mean closure time by the end of the study period was 2.2 years. All but two patients chose to keep their prosthesis in place, for a retention rate of 90%. Seven patients with successful closure had failed previously with prior prosthesis sized without the current 3-D printing methodology. This 90% retention rate exceeded the previous rates before the introduction of 3-D sizing.
Sizing done by 3-D printing for prosthetic closure of nasal septal perforations resulted in a higher retention rate in helping patients with these most-challenging nasal septal perforations.
自1972年以来，梅奥诊所为有症状且不适合手术的大鼻穿孔患者提供定制假体闭合的选择。尽管鼻中隔假体帮助了许多患者，但1982年前的患者中有27%选择不佩戴假体。二维计算机断层扫描（CT）测量尺寸使更多患者选择保留假体。三维（3-D）打印技术引入尺寸测量过程，有望通过优化假体贴合度进一步提高保留率。
描述使用3-D打印进行尺寸测量来制造鼻中隔假体，并比较3-D尺寸测量的假体与使用先前尺寸测量方法的假体的保留率。
对连续21例使用3-D打印模板测量尺寸后植入鼻中隔假体的患者进行研究。利用CT图像数据打印出患者鼻中隔穿孔精确形状的3-D模板，并制作适合的医用级硅橡胶假体。在4例病例中，3-D打印模板实现了术前手术模拟。收集的指标包括假体保留情况；症状，包括鼻内结痂和鼻出血；以及先前假体闭合失败情况。
21例患者中有20例症状得到改善。穿孔的平均直径为2.4厘米；到研究期末的平均闭合时间为2.2年。除2例患者外，所有患者都选择保留假体，保留率为90%。7例成功闭合的患者此前使用非当前3-D打印方法测量尺寸的假体时失败。这90%的保留率超过了引入3-D尺寸测量之前的比率。
通过3-D打印进行尺寸测量来闭合鼻中隔穿孔，在帮助患有这些极具挑战性的鼻中隔穿孔的患者方面，保留率更高。
