Introduction of 3D Printing in a German Municipal Hospital-Practice Guide for CMF Surgery.

Study Design: This study aimed to introduce 3D printing in a municipal hospital to improve the treatment of craniomaxillofacial patients and optimize costs and operating time. Thus we describe the implementation of low-cost in-house 3D printing to facilitate orbital- and mandible reconstruction in CMF surgery. Moreover, we address legal requirements, safety at work, fire- and data protection. Finally, we want to share our experiences using 3D printing and point out its advantages in providing better patient care. Methods: We outline the setup of in-house 3D printing and focus on obeying German health care regulations. We based our approach on a fused deposition modeling 3D printer and free software. As proof of concept, we treated 4 cases of severe orbital trauma and 1 case of mandibular reconstruction. We printed a 3D patient-specific model for each case and adapted a titanium mesh implant, respectively, a titanium reconstruction plate before performing the surgery. Results: Our approach reduced costs, duration of anesthesia, operating time, recovery time, and postoperative swelling and increased the revenue. Functional outcome in orbital reconstruction like eye movement and double vision, was improved compared to the conventional technique. No severe complications like loss-of-vision or surgical revision occurred. Likewise, mandibular reconstruction showed no plate loosening or plate fracture. Conclusion: The implementation of cost-efficient 3D printing resulted in successful patient treatment with excellent outcomes. Our practice guide offers a 3D printing workflow and could be adapted to fit the needs of other specialties like neurosurgery, orthopedic surgery as well.