For the first time in the United States, a patient has undergone a complex and intricate series of surgical procedures to implant a fully functional, three-dimensional (3D) printed “model” of a human nose. New York Eye and Ear Infirmary of Mount Sinai surgeons Tal Dagan, MD, Associate Adjunct Surgeon, and Grigoriy Mashkevich, MD, Assistant Professor of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, performed the operations on Dallan Jennet, a 14-year-old boy from the Marshall Islands. Dallan’s face was disfigured at the age of 9 after he fell onto a live power line, severely burning his entire face and losing his nose.
“The procedure is akin to a ‘nose transplant’ in that we were able to replace the nose with a functional implant,” says lead physician Dr. Dagan. “This procedure may be a breakthrough in facial reconstruction because the patient will never have to deal with the standard issues of transplantation, such as tissue rejection or a lifetime of immunosuppressive therapies.”
Dallan flew halfway around the world to New York City for the opportunity to live a normal life with the help of Canvasback Missions, Inc., a nonprofit organization that brings health care and health education to the Pacific Islands. Treatment began in early 2015 in the Marshall Islands, where the patient underwent the first of five surgeries. Expanders were inserted under the remaining skin of his nose, creating space under his skin for the actual reconstruction, which would be performed at New York Eye and Ear Infirmary.
Dr. Dagan and a team from Oxford Performance Materials, Inc., a leading advanced materials and additive manufacturing (3D printing) company, created a 3D printed facial device that would replicate a natural nose in appearance and functionality. Unlike a standard implant, the device was created using sample models taken from the noses of the patient’s close family members to recreate the most natural and culturally appropriate graft. It also allowed the surgeons to rehearse the complex procedure and create a custom operation to minimize complications.
In June, during the first, 16-hour surgical procedure at New York Eye and Ear Infirmary, Dr. Dagan and Dr. Mashkevich utilized new laser-based technology to scan the surface of the patient’s face and visualize the blood vessels feeding his skin. This helped them determine if the skin was healthy enough for reconstruction. With tissue and blood vessels harvested from Dallan’s thigh, the surgical team removed large amounts of scar tissue, inserted the graft, and reconstructed the skin over the 3D implant. They performed four additional surgeries and follow-up outpatient exams between June and October. The result was a full reconstruction of Dallan’s nose, with his senses of smell and taste restored. The implant is permanent, flexible, and will not need to be replaced as he continues to grow.
“We believe that this procedure will allow the patient to live a happy and productive life,” says Dr. Mashkevich. “We also hope that this approach will be a viable option for others with severe facial deformities who require reconstructive surgery.”
New York Eye and Ear Infirmary, Dr. Dagan, and the Visiting Nurse Service of New York provided medical care and equipment for the case. Canvasback Missions provided the necessary funding for the patient and his mother to travel to and stay in the United States during his medical care.