The programmers reconstructing faces and reducing stress for disfigured patients

People disfigured in accidents, war or from cancer have to wait months for an artificial nose or ear. So, a team of robotics developers at Portuguese company, Roboptics, has stepped in to find a faster way to rebuild damaged faces with 3D printed prostheses.

A silicon 3D-printed solution to disfiguration

Groups like Face Equality International state that if someone is badly burned, disfigured through an accident, war or disease or born with a facial difference, they often suffer social stigma in our society, which has a narrow definition of beauty. As well as essential psychological support, plastic surgeons can play a role in giving people confidence.

However, facial reconstruction to bony areas, like the ears and nose isn’t always possible (even after numerous painful surgeries), and offering the patient a prosthetic nose or ear is sometimes the only or best solution. As a result, an estimated 20,000 prosthetic noses and ears are needed a year in Europe alone.

“Their colour and shape have to be absolutely perfect,” says Filipe Jesus, a Portuguese systems engineer at μRoboptics, the company helping to develop an innovative new way to produce silicon prostheses quicker and cheaper using 3D printing.

Perfect facial imitation prostheses

F. Jesus holds up a successful prosthetic nose and ear for inspection. Detached from a face they are hollow, so as to be held in place by a bridge containing magnets. In all other respects, they look exactly like biological noses and ears. Designed to match the skin tone of an individual’s face, no one would spot they are made of silicon.

“If the nose and ears we produce don’t absolutely blend into the face, or if you can say: ‘That’s not his nose!’ then you’ve failed. The patient needs it to blend into his face to feel socially confident.” – F. Jesus

Nor would anyone know those prostheses took just three days to be produced with the help of a 3D printer. F. Jesus was part of an R&D team that developed a method called FacePrint, which they are now working on commercialising. Using it, doctors can upload a CT scan of a patient’s face onto an application, along with patient information.

The system draws on a database (built up with artificial intelligence) to produce an ear or nose mould matching the patient’s features and skin tone. Adjustments can be made using an intuitive graphical user interface, and doctors validate the ear or nose shape the computer generates before sending it for 3D printing. Silicon is then poured into the mould to produce the final ear or nose. Placements containing magnets to attach the nose or ear to the face are also printed on the 3D printer.

F. Jesus and the two founding partners of μRoboptics, Luis Tavares and Ricardo Ferreira, are all former students of the Lisbon-based Instituto Superior Técnico. As the name of their company suggests, the trio are engineers who use computer vision methods (such as scanning and robotics) to create products for all sorts of companies.

With FacePrint, μRoboptics are answering the needs of doctors who complain their patients have to wait three months or longer for a prosthesis, which can exacerbate stress, and result in as many as seven visits to a hospital to achieve perfection.

“Our FacePrint method would be a real leap forward for doctors and patients, taking just 72 hours.” – Tavares

A virtual face magician

The current method to offer a prosthetic nose or ear involves a maxillofacial surgeon, who specialises in reconstructive surgery on the face, head and neck, working with a little-known professional called an anaplastologist.

Anaplastologists currently have to spend long hours producing the moulds for the silicon prostheses, a process made more complicated by the fact there are very few trained anaplastologists in the world. The team at μRoboptics and their Eureka project partners showed how computer modelling can speed up the anaplastologist’s work, or even replace it in regions where there are no skilled professionals. Moreover, the method has the advantage that future prostheses can be accurately replicated if successful.

An experienced anaplastologist was key to the work carried out in the project, as were maxillofacial surgeons at Vu Medical Center in the Netherlands, who explained the needs of disfigured patients to the computer programmers.

While μRoboptics produced the computer modelling for the moulds, Danish company Purple Scout developed the FacePrint application for doctors to design the prostheses. It’s a cloud-based software which allows doctors to make detailed changes to an artificial ear or nose.

Floppy facial features

Dutch company Oceanz, specialists in 3D printing for medical applications, led the project and were tasked with designing the 3D printing process and commercialising the printing of the prostheses. Finally, German company Nanotecmarin, a specialist in 3D materials for prostheses, including research using live cells, focused on choosing the best biocompatible 3D printing materials and pigments for FacePrint.

Learning to 3D print tailormade noses and ears successfully involved a lot of iterations (as many as 50, estimate the developers). “Some of the ears and noses were too floppy. Some of them had air bubbles in them. Sometimes the colours were wildly wrong.” recalls F. Jesus. “The materials had to contain some rigidity and be biocompatible because they sit against someone’s skin and bone,” adds Tavares.

Flexible international collaboration

And that’s where international collaboration proved decisive; for morale and overcoming technical obstacles, believes F. Jesus. “Initially, we started out with everyone working on their part of the product, assigned according to their specialities, but as we got more comfortable with each other, we started reaching out to ask partners to re-test, remodel or work out problems.”

“We really started to learn from each other and to collaboratively thrash out solutions.” – F. Jesus

This comfortable working relationship helped in testing times, such as during the COVID-19 pandemic, which made face-to-face meetings impossible for a time, reducing the amount of patient testing that was possible at the Dutch clinic.

The team battled on to reach the moment they had long awaited: 15 researchers flew in from Portugal, Germany and Denmark to gather at Oceanz’s Amsterdam printing facility to see the perfect nose and ear being produced before their very eyes. F. Jesus recalls, “It was awesome. There was the proof of concept. We could see this works”.

“As programmers we like to do things we can touch, and these ears and noses will directly impact other people’s lives.” - Tavares

The engineers’ part in the FacePrint product is now over, and it falls to their project partners to steer the innovation through the important stages of commercialisation and regulatory approval. Tavares hopes the method, which could theoretically be adapted to produce other body parts, makes it to the market soon. It would play an invaluable role in Europe, where doctors say there is a greater demand for treatments for facial disfiguration, as survival rates from diseases like cancer increase.

Since the method can cut costs by 65%, it could help medical professionals in developing countries even more. “The feedback we’ve received so far is great,” says Tavares. “Surgeons say it’s a product that they really need.”

μRoboptics and the Face4Print project won Eureka's Best Portuguese Project award in 2022.

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Posted 7 December 22