In a Boston Children’s Hospital video, Violet Pietrok’s dad Matt describes her as “a little angel baby” and “a ball of sunshine.” Her mom Alicia says Violet’s “smile and her laugh seem to be contagious.” These are words you’d expect to hear from parents of any happy little child.
Two-year-old Violet was born a twin, but she looks very different from her sister Cora. Violet was born with a rare craniofacial anomaly, but is well on the road to recovery because of the use of 3-D printing for pre-surgical planning at Boston Children’s Hospital. As WBUR News describes it, Violet was essentially born without a nose.
“We found the frontonasal dysplasia at 22 weeks,” Alicia said in the Boston Children’s video.
She shared ultrasound images and fetal M.R.I.s with Dr. John G. Meara, Violet’s plastic surgeon at Boston Children’s, well before they met in person this past fall.
“He called me and he’s like, ‘We want you guys to know it’s going to be OK — don’t panic,’” Alicia said in the Boston Children’s video.
The Children’s Craniofacial Association describes frontonasal dysplasia as a condition in which “the nose has a flat, wide appearance, and the eyes may be wide-set.” Often, as was the case with Violet, there’s a groove of varying degrees that runs down the middle of the face across the nose and a gap with extra folds of skin covering the gap on the front of the head.
The Pietroks traveled more than 3,000 miles from their home near Salem, Oregon, to Boston Children’s, which has been a pioneer in its use of 3-D printing to help with pre-surgical planning. Violet’s doctors at home didn’t have any experience with her condition.
Several months before the surgery, Boston Children’s made an initial 3-D model of Violet’s skull based on the diagnostic images shared by her parents back in Oregon. That 3-D model was then compared to a more up-to-date 3-D model of her skull that was built a few days before her surgery last October. According to Violet’s surgical team, comparing those two models allowed them to see the growth of her skull over that time.
“I was able to sit down with the family and show them physically, ‘OK, here’s the defect in the bone. Here are the segments that need to be removed. Here’s the anatomy that’s crucial that we need to be cautious about,’” Dr. Meara told Not Impossible Now.
“It relieved a lot of their anxiety just because I was able to have a tangible discussion with them, as opposed to something that’s very theoretical. No one would or should have an understanding of this kind of a defect. So when you talk to parents normally, you’re describing these things that are very hard for them to conceptualize. A model makes it much more tangible to them,” Dr. Meara explained.
The 3-D printer, which costs about $400,000 and sits in the basement of the hospital, uses “a layer of liquid plastic rather than ink,” The New York Times reported. Layers continue to form until a three-dimensional print of the patient’s anatomy is created.
Dr. Peter Weinstock, the director of Boston Children’s Pediatric Simulator Program, told The Times that the surgical simulation program he developed helps surgeons at his hospital and at a dozen pediatric hospitals around the world.
“The value of a [3-D] model like this is huge,” Dr. Meara said in Boston Children’s video, while holding a model of Violet’s skull before her surgery. “This gives me the ability to see on this model better than I will in the operating room.”
With the 3-D models of Violet’s skull, her surgical team could see and feel the trajectory of where they needed to make certain cuts during the surgery. Violet’s surgery, which lasted nine hours, required seven surgeons and a team of nurses and caregivers, according to Boston Children’s.
“It saves a lot of the sort of thinking in the operating room,” Dr. Mark Proctor, a neurosurgeon who also served on Violet’s healthcare team, said in a Boston Children’s video. “So when we get there and the patient’s in front of us, we’re not then using our brain power to decide what do we have to do. We really have that plan going into surgery.”
Violet and her family are back home in Oregon now. Her doctors anticipate the need to do additional surgical procedures to fine-tune things before the toddler enters kindergarten.
Learn more about Violet’s story at the Boston Children’s Hospital website.
Top photo credit: Katherine C. Cohen/Boston Children’s Hospital