Losing half of his jaw to cancer didn't just affect how John Manwaring looked, it meant he had trouble breathing, speaking and eating.
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But an idea concocted a decade ago by Australian surgeon Michael Wagels using a groundbreaking biodegradable 3D implant designed by Australian-Singaporean bone and tissue regeneration company, Osteopore - and one courageous patient - has resulted in a jaw-dropping success story.
Mr Manwaring, 58, from Rockhampton in central Queensland, had originally had his jaw reconstructed using a part of a bone in his leg - the most commonly adopted method. But the bone disintegrated following further cancer treatment.
"He was actually out of options," clinical director at Brisbane's Herston Biofabrication Institute, Dr Wagels told AAP.
"He'd already endured so much. So, being out of options made him an ideal candidate for this.
"You could tell from meeting this patient that he was a courageous person. It was so clear that he was going to give his all. And he trusted us enough to give our all as well and give him something that would work."
Many years ago, Dr Wagels had come up with a solution to just this type of predicament: a special 3D implant is printed and a little shaving of the lining of the bone is wrapped around the implant.
"That's really where the magic happens," Dr Wagels said.
Mr Manwaring's body will regenerate bone tissue inside the scaffolding of the implant, which - over the next two years - will slowly be absorbed into the body.
The result is the perfect trifecta of groundbreaking technology, heroic surgical technique and the human body's incredible ability to regenerate.
"We replace something that's lost with something that is not permanent, it's going to disappear, and it's essentially going to turn into the patient's own tissues, which is really exciting to me," Dr Wagels said.
Not having to perform a second surgery to harvest bone to be used as an implant reduces the overall risk to the patient, he says.
And if everything happens as it should - Mr Manwaring's jaw rebuilds itself and the implant dissolves - the risk to the patient is reduced again.
"There's a belief in surgery in general - but reconstructive surgery in particular - which is, all implants fail eventually," he said.
"It could break, it could become exposed, it could become infected - and those risks are lifelong.
"If the implant disappears, then we hope we can show that the risk profile is much more favourable."
New bone forming is nothing new, but the breakthrough is directing and supporting the growth of that regenerated bone into the scaffolds of the implant, so it's not just bone cells but also blood vessels that regenerate to keep the cells alive.
"Because of the way we 3D printed the implant, it has the propensity to enable tissue and vessels to grow into it, not just around it, but through the entire volume of the scaffold," Osteopore's Dr Jing Lim said.
"That is really down to the porous structure that we incorporated during the printing process, and the understanding of what sorts of materials would be best suited to facilitate this regeneration."
It will take about two years for the implant to harmlessly dissolve in the body, he says.
Mr Manwaring is proud to be part of the world first surgery, which he hopes will make a difference for other people facing similar reconstructions.
"It surprised me that this can be done so close to home, not America, and it's fantastic that this is available," he says.
"It feels good to know that this technology can help someone else."
Dr Lim describes the surgery as a milestone achievement.
"The biomechanics and biology of the jaw are fairly complex; therefore, the design and manufacture of this implant was not straightforward," he said.
"But seeing it live in a human being and the impact it causes for the patient - I think that's really, truly amazing."
Dr Wagels and Dr Lim agree the breakthrough is an exciting development for future patients.
"I think we are really at this, at this place, where the technology is ready to take off," Dr Lim said.
As for Mr Manwaring, as well as being able to eat, speak and breathe more easily, he will face less anxiety about his appearance, Dr Lim believes.
"With a jaw that looks more normal than in the past, that social anxiety would be reduced substantially," he said.
"We don't only go for the function, right? We want to have a good quality of life.
"And I think, really, the combination of technology and surgical skill has made that possible."
The Herston Biofabrication Institute is part of the Queensland government's Metro North Health service. Mr Manwaring's surgery took place at Royal Brisbane and Women's Hospital.
Australian Associated Press
