Difficult airways: a 3D printing study with virtual fibreoptic endoscopy.

Head and neck cancer patients present unique airway challenges, and oropharyngeal, laryngeal, and hypopharyngeal tumours considerably distort and narrow the anatomy of the airway. We describe the use of 3D augmented reality software combined with 3D printed models to assess the anatomy of difficult airways and to assist in the formulation of the most optimal airway management strategy in such patients. The reported patients had computed tomograms (CT) of the neck prior to their anaesthetic and surgical management. DICOM files of the respective scans were imported to 3D rendering software (OsiriX, Pixmeo). We constructed volume rendered models for initial assessment of the airway then generated serial surface rendered models to create a virtual endoscopic path of the airway to simulate the fibreoptic approach. To further facilitate the study of difficult airways we have subsequently printed 3D models of those that were most difficult using rapid prototyping. Head and neck tumours significantly distort the airway. Thorough study of the relevant anatomy prior to airway management for operating reasons enhances communication between the surgeon and anaesthetist, and aids selection of the most appropriate intubation approach. In conclusion, this paper highlights a useful and novel pre-assessment strategy that allows a virtual, visual, 3-dimensional assessment of the airway anatomy combined with 3D modelling and 3D printing. This enables the airway specialist, anaesthetist, and head and neck surgeon to anticipate any critical steps and adjust the plan accordingly.

Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap.

The standard of care for head and neck reconstruction is microvascular free-tissue transfer. Various techniques of soft tissue, free-flap design have previously been described. Patient-specific planning and 3D printing have changed practice in bony reconstruction, but are not currently used in soft tissue head and neck reconstruction. We present the first report of Personalised pAtient-specific plaNning of SOFt tissue recOnStruction, the "PANSOFOS" flap, and aim to prove that the technique has a place in soft tissue reconstruction of the head and neck. Using the IDEAL framework for the reporting of surgical innovations (IDEAL stage 1, proof of concept report), we describe the case of a patient with oral cancer who had reconstruction of the tongue after hemiglossectomy. The staging scans, 3D printer and software were used to create a soft silicon resection guide and flap harvesting guide. The 3D guide was then used to design a 2D outline of the perimeter of the flap, and a negative silicone mould used to control its bulk. The procedure was successful and the postoperative period uneventful. The oncological, cosmetic, and functional outcomes were excellent. The patient followed the local enhanced recovery pathway and was discharged home with safe swallowing. This report confirms that patient-specific 3D planning can be used in the reconstruction of soft tissue defects of the head and neck. We aim to develop the technique using the next stages of the IDEAL framework, and anticipate that the PANSOFOS flap will become a standard of care.