Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Surgical 3D Printing Lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Otolaryngol Head Neck Surg. 2019 Dec;161(6):1012-1017. doi: 10.1177/0194599819878699. Epub 2019 Sep 24.
To study optimal head position after intratympanic steroid injections to enhance drug bioavailability.
Application of virtual and in vitro models of the intratympanic anatomy.
The surgical 3-dimensional printing laboratory of a tertiary academic medical center.
A high-resolution computerized tomographic scan of healthy temporal bone and surrounding soft tissue was segmented and reconstructed to a 3-dimensional model. The tympanic membrane was perforated in the posterior-inferior quadrant. Methylene blue-stained 10-mg/mL dexamethasone was administered to the middle ear cleft, after which a 3-dimensional rotation in space was performed to hypothesize the optimal position in relation to gravity. The same stereolithography file used for the actual model was used for a digital virtual liquid flow simulation. The optimal head position was defined as the one with the maximum vertical distance between the round window membrane and the plane of the aditus ad antrum and eustachian tube orifice.
The virtual model yielded the following position of the head as optimal: 53º rotation away from the injected ear in the vertical axis (yaw), 27º rotation toward the noninjected ear in the longitudinal axis (roll), and 10º neck extension in the transverse axis (pitch).
Virtual imaging determined that 53º and 27º yaw and roll, respectively, away and 10º pitch were the optimal position for drug delivery after intratympanic injection to the middle ear and that an erect head position provided optimal passage of steroids from the middle ear to the inner ear.
研究鼓室内类固醇注射后最佳头部位置，以提高药物生物利用度。
应用鼓室内解剖的虚拟和体外模型。
三级学术医学中心的手术 3D 打印实验室。
对健康颞骨及其周围软组织进行高分辨率计算机断层扫描，进行分割和重建为 3D 模型。在后下象限鼓膜穿孔。将亚甲蓝染色的 10mg/ml 地塞米松注入中耳裂隙，然后在空间中进行 3 维旋转，假设与重力相关的最佳位置。实际模型使用的相同立体光刻文件用于数字虚拟液体流动模拟。最佳头部位置定义为圆窗膜与鼓室入口和咽鼓管口平面之间垂直距离最大的位置。
虚拟模型得出的最佳头部位置为：在垂直轴（偏航）上距注射耳 53°旋转，在纵轴（滚动）上向未注射耳旋转 27°，在横轴（俯仰）上颈部伸展 10°。
虚拟成像确定，鼓室内注射后药物输送的最佳位置分别为 53°和 27°偏航和滚动，以及 10°俯仰，使类固醇从中耳向内耳的最佳通道为直立头部位置。
