Workflow for Robotic Point-of-Care Manufacturing of Personalized Maxillofacial Graft Fixation Hardware

As of this writing, Point-of-Care Manufacturing (POCM) occurs at a handful of advanced tertiary and quaternary care medical centers. These services are mainly limited to 3D printed anatomic models whose shapes derive primarily from CT or MR imaging. In far fewer cases, Virtual Surgical Planning (VSP) and 3D printed surgical guides are manufactured and surgical models are used to pre-bend fixation hardware, produce osteotomy guides, or in the fewest cases, fabricate personalized implants. Ensuring safe and effective POCM is highly relevant to rapidly emerging and time-sensitive personalized interventions for cardiac, trauma, cancer resection/radiosurgery, and neurological surgery. These rapidly emerging cases may not have time for current centralized production services to respond or the return on investment is insufficient motivation. However, patient awareness of the rise of POCM has put a premium on determining design and fabrication workflows that would be needed to provide these patients with personalized procedure planning, surgical guides, and implantable devices. This opportunity could also leverage Metamorphic Manufacturing (MM), Hybrid Autonomous Manufacturing (HAM), and the benefits of Integrated Computational Materials Engineering (ICME). The overarching goal of MM is to design a personalized device’s shape simultaneously with its function and a fabrication strategy that uses manufacturing modalities and device materials that can ensure the output of a device with optimal shape and mechanical performance. As an initiative in this discipline, we report here on preliminary design and early-stage, partial testing of a workflow that embraces the benefits of MM, HAM, and ICME for the design and fabrication of personalized mandibular graft fixation hardware.