Utility of three-dimensional modeling of the fetal airway for ex utero intrapartum treatment

Shahar Shalev, Liat Ben-Sira, Oshri Wasserzug, Ruth Shaylor, Shelly I. Shiran, Margaret Ekstein*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Recent technological developments in three-dimensional (3D) printing have created new opportunities for applications in clinical medicine. 3D printing has been adopted for teaching and planning complicated surgeries, including maxillofacial, orthopedic reconstructions, and airway manipulation for one-lung ventilation or airway stenting. We present here the first use of such technology to print a model from in utero imaging for intrapartum treatment planning. A 32-week fetus presented with congenital high airway obstruction syndrome (CHAOS) due to a large cervical lymphatic malformation. An ex utero intrapartum treatment (EXIT) procedure was planned to allow delivery of a viable infant. We printed a 3D model of the fetal airway by printing separate elements: mandible, tongue, mass, larynx, and trachea from the fetal MRI. The elements were stuck together maintaining correct anatomical relationships. Airway planning was then performed in consultation with a pediatric ear nose and throat (ENT) surgeon. 3D modeling in utero presents many challenges: the resolution of the 3D model generated from a fetal MRI is less crisp than from CT images, fetal position may be variable and not in a defined anatomical plane, movement artifact occurs. Nevertheless, pre-procedure simulations with the aid of 3D modeling promoted team cooperation and well-prepared management of the fetus during EXIT.

Original languageEnglish
Pages (from-to)595-598
Number of pages4
JournalJournal of Anesthesia
Issue number4
StatePublished - Aug 2021


  • Difficult airway
  • EXIT procedure
  • Fetus
  • Three-dimensional model


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