A case report detailing the use of 3D printing technology in surgical planning and decision making in ENT surgery-an axial 3D first in Northern Ireland.

INTRODUCTION AND IMPORTANCE: This case report details the first use of Axial 3D printing technology in Northern Ireland for surgical planning and decision making in ENT skull base surgery. CASE PRESENTATION: 39 year old male seen at ENT clinic with nasal congestion. CT showed multi-sinus mucosal thickening. Histology reported inverted papilloma polyp. The surgical options were modified Lothrops endoscopic sinus surgery or an open approach of frontal sinuses with osteoplastic flap and septorhinoplasty. A model 3D skull was created by Axial 3D using stereolithography 3D printing technology with photopolymer resin. The tumour was printed in a contrasting colour, which allowed clear visualisation and appreciation of tumour borders and relations to surrounding structures. The patient underwent FESS with modified Lothrops approach, achieving good clearance of polyp. CLINICAL DISCUSSION: The use of a 3D model allowed for visualisation of tumour size and relation to surrounding anatomy, particularly the absence of dural involvement within the fontal sinus. It assisted in surgical planning. The use of the 3D skull was beneficial for patient as it allowed less invasive surgery and therefore shorter recovery. It was beneficial for the hospital organisation as it lowered resource requirements of theatre time, hospital bed days and staff resources. One limitation of the 3D printed skull was that the fine lamellae ethmoid air cells were not shown due to the manufacturing process. CONCLUSION: The use of 3D printing is becoming increasingly popular as a surgical aid. We found the use of the 3D skull to be useful in individualised surgical planning for endoscopic sinus surgery.

Endoscopic 532-nm KTP laser excision of inverted papilloma of the nose and paranasal sinuses: a series of 9 patients.

Over the past 2 decades, the surgical management of inverted papillomas has evolved from extensive radical excision to more conservative surgery. We conducted a study to evaluate the results of our endoscopic approach to tumor excision with the 532-nm potassium titanyl phosphate (KTP-532) laser. Our series included 9 patients with inverted papilloma of the nose and paranasal sinuses who were treated from January 1998 through December 2003 (72 mo). Only 1 patient (11.1%) experienced a recurrence. The recurrence was detected 12 months after initial treatment, and it was successfully managed via the same endoscopic approach; afterward, the patient was still tumor-free at 2.5 years of follow-up. The good results of this endoscopic approach for lesions limited to the nose and paranasal sinuses can be attributed to excellent visualization with the endoscope and to the bloodless dissection achieved with the KTP-532 laser. We emphasize the need for frequent and long-term follow-up of these patients; a thorough endoscopic examination at every visit is extremely important.