VanKoevering Kyle K, Morrison Robert J, Prabhu Sanjay P, Torres Maria F Ladino, Mychaliska George B, Treadwell Marjorie C, Hollister Scott J, Green Glenn E
Departments of Otolaryngology-Head & Neck Surgery.
Department of Radiology, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts;
Pediatrics. 2015 Nov;136(5):e1382-5. doi: 10.1542/peds.2015-1062. Epub 2015 Oct 5.
Congenital airway obstruction poses a life-threatening challenge to the newborn. We present the first case of three-dimensional (3D) modeling and 3D printing of complex fetal maxillofacial anatomy after prenatal ultrasound indicated potential upper airway obstruction from a midline mass of the maxilla. Using fetal MRI and patient-specific computer-aided modeling, the craniofacial anatomy of the fetus was manufactured using a 3D printer. This model demonstrated the mass to be isolated to the upper lip and maxilla, suggesting the oral airway to be patent. The decision was made to deliver the infant without a planned ex utero intrapartum treatment procedure. The neonate was born with a protuberant cleft lip and palate deformity, without airway obstruction, as predicted by the patient-specific model. The delivery was uneventful, and the child was discharged without need for airway intervention. This case demonstrates that 3D modeling may improve prenatal evaluation of complex patient-specific fetal anatomy and facilitate the multidisciplinary approach to perinatal management of complex airway anomalies.
先天性气道梗阻对新生儿构成了危及生命的挑战。我们报告了首例病例,产前超声显示上颌中线肿块可能导致上气道梗阻后,对复杂胎儿颌面解剖结构进行了三维(3D)建模和3D打印。利用胎儿磁共振成像(MRI)和针对患者的计算机辅助建模,使用3D打印机制作了胎儿的颅面解剖模型。该模型显示肿块局限于上唇和上颌,提示气道通畅。于是决定在没有计划进行产时宫外治疗程序的情况下分娩婴儿。如针对患者的模型所预测,新生儿出生时患有突出的唇腭裂畸形,但没有气道梗阻。分娩过程顺利,孩子出院时无需气道干预。该病例表明,3D建模可改善对复杂的、针对患者的胎儿解剖结构的产前评估,并有助于采用多学科方法对复杂气道异常进行围产期管理。