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Rhinology/Allergy

(030) An Objective Assessment of Sinus Surgery in 3D Printed Models

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Ricardo Wray Pulido, MD

    Resident Physician
    University of Washington
    Seattle, Washington, United States

    • Senior Author(s)

  • Randall A. Bly, MD

    Fellow - Pediatric Otolaryngology
    University of Washington
    Seattle, Washington, USA

    • Co-Author(s)

  • Waleed M. Abuzeid, MD

    Associate Professor
    University of Washington
    Seattle, WA, United States

    • Senior Author(s)

  • KM

    Kris Moe, MD

    Professor
    University of Washington
    Seattle, Washington, USA

    • Co-Author(s)

  • IH

    Ian Humphreys, DO

    Associate Professor
    University of Washington
    Seattle, Washington, United States

  • AJ

    Aria Jafari, MD

    Assistant Professor
    University of Washington, USA

Disclosure(s):
Ricardo Wray Pulido, MD: No relevant relationships to disclose.
Ian Humphreys, DO: No relevant relationships to disclose.


Introduction: 3D printed models are increasingly being utilized as an adjunctive to cadavers for endoscopic sinus surgery (ESS) in courses and demonstrations; however, there is sparse data to support the ability to objectively measure extent of ESS in 3D printed models. We aim to test the ability to reliably detect expected postoperative changes on computed tomography (CT) scans in 3D printed models.

Methods: CT images were imported into the software system, Materialise Mimics (Leuven, Belgium), for segmentation of underlying sinus anatomy. The 3D model was printed based on anatomic presets to delineate the soft tissue and bony components as defined in current literature. The model underwent a preoperative CT scan and ESS was subsequently performed on 5 separate sinus inserts, each side of the insert acting as a separate sinus, for a total of 10 sinuses. The procedures performed were maxillary antrostomy, total ethmoidectomy, sphenoidotomy, frontal sinusotomy, and middle turbinate reduction. Each sinus underwent varying degrees of each listed sinus procedure and was performed by the resident physician. A postoperative CT scan was then completed for all sinus inserts and evaluated by 6 experienced sinus surgeons based on the extent of each procedure.

Results: The 6 experienced sinus surgeons individually evaluated each of the 10 postoperative sinuses to determine inter-rater reliability. A Fleiss Kappa of 0.51 (p < 0.001; 95% CI: 0.33-0.7) was found for maxillary antrostomies. Fleiss Kappa of 0.53 (p < 0.001; 95% CI: 0.36-0.71) for ethmoidectomies. Fleiss Kappa of 0.53 (p < 0.001; 95% CI: 0.36-0.71) for middle turbinate reduction. Fleiss Kappa of 0.24 (p = 0.021; 95% CI: 0.04-0.44) for frontal sinusotomies. Fleiss Kappa of 0.36 (p = 0.002; 95% CI: 0.13-0.59) for sphenoidotomies.

Conclusions: Our sample of experienced sinus surgeons evaluating our 3D printed model moderately agreed upon the extent of completion of maxillary antrostomies, ethmoidectomies, and middle turbinate reduction. Our raters mildly agreed upon the extent of completion of frontal sinusotomies and sphenoidotomies.