When I heard that Jesse Taylor, MD, assistant professor in Plastic Surgery, was using 3D computer-aided design (CAD) to plan out a surgery to restructure someone's face, I had to find out more. My father is a pattern maker by trade, and develops prototype parts and molds. After growing up talking about some of the same 3D design tools, it’s fascinating to see how the latest technical innovations are now helping patients with facial malformations.
Dr. Taylor walked me through a recent surgery, one of the most complicated cases he's done, of a patient whose facial structure was significantly impacted by a rare genetic condition called Saethre-Chotzen syndrome (SCS).
The human eye is very discerning. The more symmetrical a face is, or how balanced facial features are, the more attractive we perceive it to be. One study our psychiatrists did here at Penn a few years ago showed that the cuter the baby, the more care they may have been able to solicit. On an evolutionary level, in times where caretaking duties were spread to group members beyond the mother, this extra attention would help the children receive better care. Even a slight imbalance, anything over 1 millimeter, in facial features - vertically, horizontally or depth-wise - can cause our eyes to do a double-take.
In Dr. Taylor's recent case, the patient had horizontal, vertical and depth asymmetries. Her right eye was 5 millimeters lower than her left eye, and 5 millimeters further away from the center line of her face (5 millimeters is about the size of a number on a credit card). Her forehead was a full centimeter behind where it should be, where it could potentially press on her brain.
As the surgeons prepared for the surgery, they worked with a company that uses computer software to take a CT scan and turn it into a 3-dimentional image, helping Dr. Taylor manipulate and plan every move in this complex surgery.
Once everything was mapped out, Dr. Taylor received custom jigs - a plastic template - for this surgery, to serve as a cutting guide and outline places in the facial bones to drill holes for the plates to hold the bones together. Without the template, it would've taken the surgeons a few hours to get things lined up before surgery. With the templates, it took less than 5 minutes.
In the surgery, which took six hours (significantly less than the 8-12 hours it would take without templates), they first lifted off the skin, then, with the help of Neurosurgery chair M. Sean Grady, cut into the skull bone. They then moved all the bones as planned and ensured that there was a water-tight seal between the nose and brain. Once things were moved and locked in place, they were able to re-drape the facial skin and complete the surgery.
A few weeks after the surgery, the patient is back at work and doing well. "This surgery changed her life," said Dr. Taylor. "Now, she's more comfortable when she goes to the grocery store and is out and about."
Starting in April, Dr. Taylor and a team of surgeons from Plastic Surgery, Neurosurgery, Oral and Maxillofacial Surgery and Oculoplastic Surgery, will start seeing patients monthly in the Adult Craniofacial Reconstruction program. People who are interested in having their case reviewed by the team can find more information online.