TY - JOUR
T1 - Utility of three-dimensional modeling of the fetal airway for ex utero intrapartum treatment
AU - Shalev, Shahar
AU - Ben-Sira, Liat
AU - Wasserzug, Oshri
AU - Shaylor, Ruth
AU - Shiran, Shelly I.
AU - Ekstein, Margaret
N1 - Publisher Copyright:
© 2021, Japanese Society of Anesthesiologists.
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - Difficult airway
KW - EXIT procedure
KW - Fetus
KW - Three-dimensional model
UR - http://www.scopus.com/inward/record.url?scp=85107338829&partnerID=8YFLogxK
U2 - 10.1007/s00540-021-02950-8
DO - 10.1007/s00540-021-02950-8
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C2 - 34075478
AN - SCOPUS:85107338829
SN - 0913-8668
VL - 35
SP - 595
EP - 598
JO - Journal of Anesthesia
JF - Journal of Anesthesia
IS - 4
ER -