RESEARCH ARTICLE 3D Rapid Prototyping for Otolaryngology — Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling Harley H. L. Chan 1 , Jeffrey H. Siewerdsen 4 , Allan Vescan 5,6 , Michael J. Daly 1,3 , Eitan Prisman 7 , Jonathan C. Irish 1,2,5 * 1 TECHNA Institute, University Health Network, Toronto, Ontario, Canada, 2 Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada, 3 Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada, 4 Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States of America, 5 Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada, 6 Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada, 7 Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia *
[email protected] 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 partic- ipated 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 fur- ther 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 dif- ferences 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 PLOS ONE | DOI:10.1371/journal.pone.0136370 September 2, 2015 1 / 18 OPEN ACCESS Citation: Chan HHL, Siewerdsen JH, Vescan A, Daly MJ, Prisman E, Irish JC (2015) 3D Rapid Prototyping for Otolaryngology — Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling. PLoS ONE 10(9): e0136370. doi:10.1371/journal.pone.0136370 Editor: David Warburton, University of Southern California, UNITED STATES Received: March 17, 2015 Accepted: August 3, 2015 Published: September 2, 2015 Copyright: © 2015 Chan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work is supported by the TECHNA- Guided Therapeutics (GTx) Program at the University Health Network, including The Kevin and Sandra Sullivan Chair in Surgical Oncology, The Hatch Engineering Fellowship Fund, The RACH Fund, The Princess Margaret Cancer Foundation and National Institutes of Health (R01-CA127944-02). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. OCTOBER 2019 | The Surgical Technologist | 469