THREE-DIMENSIONAL printed continuous positive airway pressure masks in children with maxillofacial deformities with obstructive sleep apnea

Sleep disordered breathing (SDB) is common in the paediatric population and negatively impacts quality-of-life, daytime functioning and the cardiovascular system. Non-invasive ventilation (NIV) is a viable treatment option for SDB when surgical management is not appropriate. NIV is delivered via a standardised oro/nasal facemask. Suboptimal mask fit from excessive tightness can lead to pressure ulcers, rashes, and discomfort; while poor fit with air leakage can lead to ineffective therapy, eye irritation and sleep disturbances. Mask fit plays a key role in compliance and effectiveness of NIV treatment. 3D-printing can produce a customised interface, improving fit and therefore therapy adherence. No published reports of 3D-printing application in the setting of paediatric BiPAP masks exist. We describe 3D-modelling of a patient's face and the process of digital-moulding using computer-aided design to create a BiPAP mask insert, hypothesising that a customised fit will improve adherence and effectiveness. The patient's face was scanned and 3D modelling with a computer-aided design was used to create a BiPAP mask insert. Patient feedback was assessed with three validated questionnaires (completed by the patient's mother) before and after use. An 8-year-old female with SDB, with congenital scoliosis and right-sided chest wall deformity, did not tolerate a conventional CPAP mask. A change to a BiPAP mask improved her comfort but air leaks resulted in left periorbital erythema and poor compliance. After the introduction of the 3D-printed BiPAP mask insert, the patient's mother reported improved comfort and fit with no air leaks, resolving periorbital oedema and improved compliance. We report the novel use of 3D-printing for a BiPAP mask in the first paediatric case in Australia. This use of personalised medicine is valuable in improving therapy compliance and patient outcomes.