From the Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia.
Discipline of Child and Adolescent Health, The University of Sydney, Australia.
Anesth Analg. 2021 Nov 1;133(5):1251-1259. doi: 10.1213/ANE.0000000000005260.
Pediatric airway models currently available for use in education or simulation do not replicate anatomy or tissue responses to procedures. Emphasis on mass production with sturdy but homogeneous materials and low-fidelity casting techniques diminishes these models' abilities to realistically represent the unique characteristics of the pediatric airway, particularly in the infant and younger age ranges. Newer fabrication technologies, including 3-dimensional (3D) printing and castable tissue-like silicones, open new approaches to the simulation of pediatric airways with greater anatomical fidelity and utility for procedure training.
After ethics approval, available/archived computerized tomography data sets of patients under the age of 2 years were reviewed to identify those suitable for designing new models. A single 21-month-old subject was selected for 3D reconstruction. Manual thresholding was then performed to produce 3D models of selected regions and tissue types within the dataset, which were either directly 3D-printed or later cast in 3D-printed molds with a variety of tissue-like silicones. A series of testing mannequins derived using this multimodal approach were then further refined following direct clinician feedback to develop a series of pediatric airway model prototypes.
The initial prototype consisted of separate skeletal (skull, mandible, vertebrae) and soft-tissue (nasal mucosa, pharynx, larynx, gingivae, tongue, functional temporomandibular joint [TMJ] "sleeve," skin) modules. The first iterations of these modules were generated using both single-material and multimaterial 3D printing techniques to achieve the haptic properties of real human tissues. After direct clinical feedback, subsequent prototypes relied on a combination of 3D printing for osseous elements and casting of soft-tissue components from 3D-printed molds, which refined the haptic properties of the nasal, oropharyngeal, laryngeal, and airway tissues, and improved the range of movement required for airway management procedures. This approach of modification based on clinical feedback resulted in superior functional performance.
Our hybrid manufacturing approach, merging 3D-printed components and 3D-printed molds for silicone casting, allows a more accurate representation of both the anatomy and functional characteristics of the pediatric airway for model production. Further, it allows for the direct translation of anatomy derived from real patient medical imaging into a functional airway management simulator, and our modular design allows for modification of individual elements to easily vary anatomical configurations, haptic qualities of components or exchange components to replicate pathology.
目前可用于教育或模拟的儿科气道模型无法复制解剖结构或对手术的组织反应。强调大规模生产、使用坚固但均匀的材料和低保真度铸造技术，降低了这些模型逼真地代表儿科气道独特特征的能力，尤其是在婴儿和年龄较小的年龄段。包括 3 维（3D）打印和可铸造类组织硅酮在内的较新技术为儿科气道模拟开辟了新途径，提供了更高的解剖保真度和用于手术训练的实用性。
在获得伦理批准后，对 2 岁以下患者的现有/存档计算机断层扫描数据集进行了审查，以确定适合用于设计新模型的数据集。选择了一名 21 个月大的单一患者进行 3D 重建。然后，手动进行阈值处理，以生成数据集中选定区域和组织类型的 3D 模型，这些模型可直接 3D 打印，也可稍后在具有各种类组织硅酮的 3D 打印模具中铸造。使用这种多模式方法获得的一系列测试模型，根据直接临床医生的反馈进行了进一步改进，以开发一系列儿科气道模型原型。
初始原型由单独的骨骼（颅骨、下颌骨、脊椎骨）和软组织（鼻黏膜、咽、喉、牙龈、舌、功能性颞下颌关节[TMJ]“袖套”、皮肤）模块组成。这些模块的第一个迭代是使用单一材料和多材料 3D 打印技术生成的，以实现真实人体组织的触觉特性。在获得直接临床反馈后，随后的原型依赖于 3D 打印用于骨骼元素和从 3D 打印模具铸造软组织组件的组合，这改进了鼻、口咽、喉和气道组织的触觉特性，并提高了气道管理程序所需的运动范围。这种基于临床反馈的修改方法可实现卓越的功能性能。
我们的混合制造方法结合了 3D 打印组件和用于硅酮铸造的 3D 打印模具，可更准确地代表儿科气道的解剖结构和功能特征，用于模型生产。此外，它允许直接将来自真实患者医学成像的解剖结构转化为功能气道管理模拟器，并且我们的模块化设计允许修改单个元素，以轻松改变解剖结构、组件的触觉质量或更换组件以复制病理学。
