3D Printed Surgical Guides Applied in Rhinoplasty to Help Obtain Ideal Nasal Profile

Overview

Computer simulation is increasingly used in rhinoplasty consultation, and the authors argue its value extends past converting patients into surgery. Simulated results can guide planning and decisions during the operation itself. This study evaluated 3D printed guides, made from those simulations, as an intraoperative reference for setting bridge height and tip position.

Sections of note

• Fifteen patients met inclusion criteria; the journal assigns level of evidence V.
• Each patient had a preoperative virtual 3D surgical simulation.
• Simulations were used to make a printed nasal kit containing ceramic models of the current and simulated nose, a sagittal contour guide and a custom postoperative splint.
• Guides were sterilized so the profile contour could be checked repeatedly during surgery.
• Postoperative 3D images taken at 1 to 3 months were compared with the preoperative simulations.
• Differences in the z and y coordinates were used to measure differences in projection and rotation.
• Final tip position averaged 0.8 plus or minus 0.7 mm from simulated projection and 0.3 plus or minus 0.2 mm from simulated rotation.
• Projection of the cartilage and bony parts of the bridge was within 1.0 plus or minus 0.8 mm and 0.8 plus or minus 0.7 mm of the simulation.

What it means for a patient

• The guides let the surgeon check during surgery whether the nose matches the plan shown before it.
• Final results fell within roughly a millimetre of the simulation on every measurement.
• Fifteen patients with no control group cannot show the guides caused that accuracy.
• Follow up imaging at 1 to 3 months is early, since swelling and settling continue after that.

Why this paper matters

Simulation is commonly shown to patients as an expectation setting tool, and the gap between simulation and result drives dissatisfaction. This study measures that gap directly with a method for closing it. Whether accuracy at 1 to 3 months persists, and whether patients notice the difference, is untested.

Terms

• 3D printed surgical guide: a physical template printed from a digital plan and used during surgery.
• Virtual simulation: a digital preview of the intended surgical result.
• Projection: how far the tip or bridge stands out from the face.
• Rotation: how far upward or downward the tip is angled.
• Sagittal contour: the profile outline of the nose viewed from the side.