Three-Dimensional Modeling of the Temporal Bone for Surgical Training

Introduction: The anatomy of the temporal bone (TB) can only be mastered by repeated surgical and anatomic dissections, and surgical teaching initiative had a major effect on outcomes. The aim of this study was to investigate the validity of an artificial TB model devoted to surgical training and education. Materials and Methods: A helical computed tomographic (CT) scan was used to acquire high-resolution data of cadaveric TB. Digital imaging and communications in medicine (DICOM) data were converted into.stl files after data processing. Cadaveric TBs were prototyped using stereolithography. The validation of the prototype needed several steps. First of all, we have studied on CT scan the positional relationship between the facial nerve and other structures of the cadaveric TBs and prototyped bones. Otoendoscopy of the middle ear and the internal acoustic canal and visualization of anatomic landmarks during TB drilling of the cadaveric TBs and prototyped bones were also performed. Results: Seven normal CT scans of cadaveric TB were selected to make prototyped bone using stereolithography. Measurements of volume and distance showed no significant difference between prototypes and cadaver TBs. Classic mastoid surgical procedures were performed in the Anatomy Department: exposing sigmoid sinus, facial nerve, labyrinth, dura mater, jugular bulb, and internal carotid artery. Two simulations of implantable middle ear prosthesis were made successfully. Conclusion: These prototypes made using stereolithography seem to be a good anatomic model for surgical training. This model could also be interesting for surgical planning in congenital ear anomalies before middle ear prosthesis implantation.

[1]  Hidenori Ono,et al.  Rapid prototyping of temporal bone for surgical training and medical education. , 2004, Acta oto-laryngologica.

[2]  D. Newble,et al.  Assessing the technical skills of surgical trainees , 2005, The British journal of surgery.

[3]  Maximilian Reiser,et al.  CT of the normal temporal bone: comparison of multi- and single-detector row CT. , 2005, Radiology.

[4]  Don Stredney,et al.  Use of Ultra-High-Resolution Data for Temporal Bone Dissection Simulation , 2005, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[5]  Gregory Chaljub,et al.  3D CT Imaging Method for Measuring Temporal Bone Aeration , 2002, Acta oto-laryngologica.

[6]  C. Kerber,et al.  Rapid prototyping to create vascular replicas from CT scan data: Making tools to teach, rehearse, and choose treatment strategies , 2005, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[7]  A. Duffy,et al.  Evolution of surgical skills training. , 2006, World journal of gastroenterology.

[8]  L. Rutqvist,et al.  Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm , 2000, The Lancet.

[9]  Hidenori Ono,et al.  Application of a rapid-prototyped temporal bone model for surgical planning , 2005, Acta oto-laryngologica.

[10]  H Löppönen,et al.  Computed tomography data based rapid prototyping model of the temporal bone before cochlear implant surgery. , 1997, Acta oto-laryngologica. Supplementum.

[11]  R. Martin,et al.  Neanderthal computer skulls , 1995, Nature.

[12]  A Millman,et al.  Virtual temporal bone: Creation and application of a new computer-based teaching tool , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[13]  M Suzuki,et al.  Rapid-prototyped temporal bone and inner-ear models replicated by adjusting computed tomography thresholds , 2007, The Journal of Laryngology & Otology.

[14]  D. López-Aguado,et al.  Incidence of dehiscences in the fallopian canal. , 1997, International journal of pediatric otorhinolaryngology.

[15]  C. Destrieux,et al.  The internal acoustic meatus and its meningeal layers: a microanatomical study. , 2002, Journal of neurosurgery.

[16]  B. Sellhaus,et al.  Fallopian canal dehiscences: a survey of clinical and anatomical findings , 2005, European Archives of Oto-Rhino-Laryngology and Head & Neck.

[17]  Methods of Teaching Stapedectomy , 1999, The Laryngoscope.

[18]  K. Hongo,et al.  CONSTRUCTION OF A THREE‐DIMENSIONAL INTERACTIVE MODEL OF THE SKULL BASE AND CRANIAL NERVES , 2007, Neurosurgery.

[19]  Adam Dubrowski,et al.  Using a Virtual Reality Temporal Bone Simulator to Assess Otolaryngology Trainees , 2007, The Laryngoscope.

[20]  W A Kalender,et al.  Rapid protyping technology in medicine--basics and applications. , 1999, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[21]  J. Winder,et al.  Medical rapid prototyping technologies: state of the art and current limitations for application in oral and maxillofacial surgery. , 2005, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[22]  A. Ladd,et al.  Evaluation of a surgical simulator for learning clinical anatomy , 2004, Medical education.

[23]  J. Y. Choi,et al.  Analysis of errors in medical rapid prototyping models. , 2002, International journal of oral and maxillofacial surgery.

[24]  P. Schmalbrock,et al.  Virtual Temporal Bone Dissection: An Interactive Surgical Simulator , 2002, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[25]  Haobing Wang,et al.  Three-Dimensional Virtual Model of the Human Temporal Bone: A Stand-Alone, Downloadable Teaching Tool , 2006, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[26]  M. Fried,et al.  The role of virtual reality in surgical training in otorhinolaryngology , 2007, Current opinion in otolaryngology & head and neck surgery.

[27]  A. Ahuja,et al.  Computed tomography imaging of the temporal bone--normal anatomy. , 2003, Clinical radiology.

[28]  J. McLachlan,et al.  Teaching anatomy without cadavers , 2004, Medical education.

[29]  D Caramella,et al.  IERAPSI project: Simulation of a canal wall-up mastoidectomy , 2006, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[30]  Keqiang Wang,et al.  Positional relationship between the facial nerve and other structures of the temporal bone , 2004, The Journal of Laryngology & Otology.

[31]  Stefan Weber,et al.  Stereolithographic models for surgical planning in congenital heart surgery. , 2007, The Annals of thoracic surgery.