A New Era for Craniofacial Surgery

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This story was originally published in the February/March 2015 issue of Chattanooga magazine.

Holding a model of the skull of a three-month-old child next to the model of a one-month-old, Dr. Larry Sargent explains a new technologically-advanced procedure that is life changing.

“The skull of an infant doubles in size during the first few months of life,” says Sargent. “It’s an important developmental time.” Infants with birth defects, disease or trauma are at a much greater risk of impaired development as corrective surgeries are undertaken, he adds.

The models are those of Chloe, a patient with Apert’s syndrome, a condition where the skull’s plates are fused together at birth, so that it does not expand to allow for brain growth. With the most advanced 3D printing technology available, he was able to do her first surgery at one month, giving her a much better chance at having a more normal rate of development.

It is the very model he has in his hand that has created this breakthrough. Made of polyethylene, it is an extremely accurate reproduction of Chloe’s skull—produced from a 3D printer that is integrated with a CT scanner.

“CT scanners and MRI’s are not new, but they are much more sophisticated than they were and they make monthly advancements,” says Sargent. “Once, it was almost impossible to get a good scan of an infant’s skull, now an infant can get a complete CT scan and it takes only a matter of seconds.

“Data from the scan is entered into software customized to integrate with a 3D printer—the software is new—and not readily available.” Sargent says it is comparable to computer animation used in the film industry. It can be programed to provide color, a variation of views—from the inside or the outside, top to bottom, side to side. It offers precise measurements and analytical data.

The finished model includes a bar or distractor that is attached to existing bone plates. It is attached to an arm, designed to turn and expand the distance between the plates. When turned by the doctor periodically it allows the brain room to expand. Later the arm is removed and the bar and screws actually dissolve.

A 3D printer reproduction of a patients skull shows fused plates that will be corrected with the attached distractor.

The model made from the scan data may be reproduced at 100 percent—the exact size of the skull. “It can also generate an entire body part that is anatomically correct,” adds Dr. Sargent. The software is expensive and must be customized to the individual scanner or MRI that is being used says Sargent. The reproduction material is advancing rapidly, too. These prosthetic products may be implanted into the body—“they are precise.” He seems filled with a renewed vigor when approaching the surgical process.

“You can hold the model in your hand and understand the problem better,” he adds. An extremely exacting physician, Dr. Sargent goes into surgery even more prepared—the parts are perfect, there is no re-fitting. The surgeries are shorter, and there are fewer of them. The result is a healthier, stronger patient.

Lately, Dr. Sargent has been working with KLS Martin, a company that specializes in maxillofacial plates and implants. Recently he was a keynote speaker at the company’s annual conference. He is collaborating with the company to write groundbreaking software that will interact with various CT scanners and MRI machines. To date, insurance does not cover the procedures, but Sargent believes that will change when the outcomes become apparent and begin saving money by eliminating surgical procedures and reducing the frequency of hospitalizations.

“Another area of advanced technology includes the polyethylene material for implant. It is somewhat porous and may be customized,” he adds. Technology makes rapid strides when talent and timing align.

“Eighty-five percent of maxillofacial patients assisted by the Craniofacial Foundation of America are from the southeastern region and they are fortunate to have the Erlanger facility, talented physicians and a creative organization to enable their recovery,” says Terry Smyth, CFA director.

Raising the profile of the foundation and the surgical group is part of what Smyth does, as she plans fundraisers and new ways to communicate with the public. Dr. Sargent and Erlanger will soon be featured in an upcoming episode of ABC’s “The Doctors” scheduled to air this May. The episode from May 14, 2014 is still on view at www.youtube.com “Erlanger and Dr. Larry Sargent on The Doctors.”

In the future, physicians may be able to purchase customized 3D printers with software, or use software by subscription, say most medical equipment developers. In the meantime, Dr. Sargent will continue to refine his software to improve the lives of his young patients.

Learn more at craniofacialfoundation.org

Dr. Larry Sargent is a plastic and reconstructive surgeon specializing in craniofacial surgery and maxillofacial trauma. He is a graduate of the Georgia Institute of Technology and Emory University School of Medicine. He completed his general surgery and plastic surgery training at the John Hopkins Hospital in Baltimore, Maryland. Dr. Sargent is Professor and Chairman of the Department of Plastic Surgery at the University of Tennessee College of Medicine in Chattanooga, a Fellow of the American College of Surgeons, a Fellow of the American Academy of Pediatrics, and board certified in plastic surgery.

Photography courtesy of CFA and KLS Martin

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Debbie is the retired Editor of Chattanooga Magazine, and ongoing contributor.

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