3D Rapid Prototyping for Otolaryngology—Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling

Abstract

The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.

Clinical applications of three‐dimensional printing in otolaryngology–head and neck surgery: A systematic review

“…3D printing of customized surgical templates and equipment further optimize operative interventions. For instance, the use of prebent reconstruction plates has been extensively documented in the literature . Using 3D rapid prototyping technology, Ro and colleagues and Prisman and colleagues investigated the value of preoperative mandibular contouring in patients undergoing reconstruction of the mandible with osseous free flap reconstruction.…”

“…3D‐printed models have been used to perform common navigation maneuvers and presurgical planning in various subspecialties, opening new avenues for their use as surgical training tools. 3D‐printed models have already been shown to be effective for training in temporal bone simulation as well as in training of microtia and endoscopic endonasal surgery …”

“…For instance, the use of prebent reconstruction plates has been extensively documented in the literature. [10][11][12][13][14] Using 3D rapid prototyping technology, Ro and colleagues 13 and Prisman and colleagues 14 investigated the value of preoperative mandibular contouring in patients undergoing reconstruction of the mandible with osseous free flap reconstruction. They both reported that preoperative contouring was beneficial in restoring the contour of the mandible postoperatively.…”

Innovations in surgery simulation: a review of past, current and future techniques

“…For example, 3D printing technology has been incorporated into hyper-realistic training models for laparoscopic pyeloplasty, thoracoscopic esophageal atresia repair and other minimally invasive surgeries (6,36). Recently, 3D printing has been used to create patientspecific models for preoperative planning of complicated procedures (37).…”

“…Some newly developed multimaterial 3D printers can produce models with multiple tissue types. As a result, some of the models produced by rapid prototyping are able to replicate actual patients' anatomical structures with remarkable realism (37,(54)(55)(56)(57).…”