“I breathe better, I smell the smell of coffee again in the morning, I feel almost normal again. » For Karine (she wishes to remain anonymous), 50, life has just resumed after a unique surgery. More than ten years after being treated for cancer of the nasal cavities (squamous cell carcinoma) by radiotherapy and chemotherapy, this resident of Tarn is the first patient in the world to have benefited from a nasal graft made of synthetic biomaterial and produced on a printer. 3D.
The feat was achieved by the ENT and cervico-facial surgery teams of the Toulouse University Hospital and the Claudius-Regaud Institute, within the Toulouse Oncopole. At their head, Professor Agnès Dupret-Bories and Doctor Benjamin Vairel treat all cancers of the mouth, tongue or facial skin.
In this specific case, the patient had lost, following heavy treatments in 2013, a large part of her nose as well as the front part of her palate. For more than four years, she lived without a nose, faced with failures of nasal reconstruction by grafting skin flaps and with difficulty supporting the wearing of a facial prosthesis (epithosis).
In 2020, Agnès Dupret-Bories, CNRS researcher at the Interuniversity Center for Materials Research and Engineering (Cirimat), who studies biomaterials, came into contact with a young PhD student in Belgium, Islam Bouabaz-Abdeljalil. With the company Cerhum, based in Liège, he has already tested synthetic implants on a patient’s cheekbones.
Can the operation succeed on an entire nose? How to revascularize the implanted nose? With what materials and under what aesthetic conditions? These are the questions the team grapples with. But, with the patient’s full agreement, the decision to attempt the operation was taken at the end of 2021.
A new kind of graft
“The first challenge was to manufacture a new type of graft, medically and technologically”, emphasizes Agnès Dupret-Bories. Cerhum was already involved in facial bone reconstruction, from unique pieces. “Our parts are manufactured with 3D printers and the technique known as stereography, the most precise, allowing the integration of porosities, channels for blood vessels”says Valentin Henriet, clinical engineer at Cerhum.
Made with hydroxyapatite, a mineral component of tooth enamel and bone, the piece looks like a complex scaffolding. It is indeed necessary that, in this “hollow maze, cells and tissues can colonize”, explains Valentin Henriet. Let the graft take between the nasal septum and the graft. “For its shape and size, we worked on the patient’s surgical data, which we have been following for a long time”says Dr. Vairel.
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