Rebuilding the face: medicine meets engineering at the beginning of an industrial revolution

Mass-production technology has revolutionized so much of modern life that we take it for granted - but early iterations of all technologies were hand-built, relying on the skills and intuition of master craftsmen for the effectiveness of each end product. It might surprise you to learn that in the field of facial reconstructive surgery, the vast majority of work is still being done in a pre-industrial revolution fashion - and results for patients who present with horribly disfiguring facial tumors or bone injuries are as varied and inconsistent as the human hands that do the work. Dr. Ninian Peckitt, originally from the UK, has pioneered a truly revolutionary "Engineering Assisted Surgery" approach that uses advanced CT-to-CAD modeling, rapid stereolithographic prototyping, pinpoint CAD design, electron beam melting (EBM) mass-production and error-eliminating surgical procedures. The results are absolutely stunning. Patients that would normally require traumatic 20-hour operations involving complicated, imprecise and ugly bone grafts are being fitted with incredibly precise, long-lasting titanium facial inserts so effective that once surgical scars fade you'd never know they had a facial injury. Surgery is simple and can often be completed in an hour or two using techniques that eliminate human errors - and the entire procedure comes in at a fraction of the price. Peckitt's work is amazing - but if powerful lobbies in the medical fraternity have their way, it may cost him his career.

Facial injuries have severe and traumatic repercussions that can make life incredibly difficult for patients - just ask New Zealander Sophie Bell. Sophie suffered a benign tumor that started in her cheek and spread to her nose and sinuses, eventually causing breathing difficulties.

The tumor was removed, and with it her palate, cheekbone, parts of her temple and eye socket. The left side of Sophie's face was rebuilt using the standard "free flap" procedures. In a long and complicated series of operations, bone was taken from her leg, sculpted into shape and implanted into her face, then connected to the blood supply in order to keep it alive and healthy.

Thanks to the skill of the surgical team, Sophie's reconstructed face looked "magnificent" when the surgery was first completed - but the subsequent swelling, gravity and other pressures on the implanted bone have caused the left side of her face to sag, dropping her eye out of alignment, giving her double vision, and resulting in a noticeable facial deformity that scared her own kids when they first saw her, and has battered her self confidence in every area of her life.

In the next couple of months, Sophie Bell will receive a titanium implant to replace the grafted bone in her face. Surgery will be incredibly fast – estimated at around three hours - and she may well go home after only a day or two in hospital with a minimal surgical procedure and minor scarring. The implant will fit perfectly against the bone, so tight at the joins that you won't be able to get a dental probe underneath it. It will be coated with a Bone Morphogenetic Protein (BMP) that causes bone to form over the surface of it, helping the skin above the implant to receive a steady blood supply. Sophie's eye will once again be supported exactly where it should be. Her vision should return to normal in time, and her pretty face will once again be whole. She will be fitted with customized dental crowns to restore her teeth. The transformation will be incredible, the impact on Sophie's life incalculable.

Dr. Ninian Peckitt, Sophie's surgeon, can say this with justified confidence, because the operation has all been planned out using the same principles that have revolutionized so many other industries across the globe: systemization, Computer Aided Design (CAD), rapid prototyping and precision engineering. He can also say that the results will last for decades, that the surgery will be many times cheaper than Sophie's original free flap procedure - and that the inserts themselves will rapidly reduce in price as production volume increases.

Peckitt, a maxillofacial surgeon originally from the UK, has been working in New Zealand's public health system for the last 2 years. Since 1993, he has been developing, trialling and refining a set of techniques he calls "Engineering Assisted Surgery" that seek a scientific, replicable and efficient alternative to free flap operations - but the true potential of the system he has pioneered goes far beyond facial reconstructions.

Peckitt's system for dealing with a case like Sophie Bell goes along the following lines:

Firstly, a high resolution CT scan is taken of the patient's skull, giving layer-by-layer dimensional data about the bone structure, the injury, any tumors and other issues.

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