Thomas Jefferson University Hospital, Department of Otolaryngology- Head & Neck Surgery, Philadelphia, PA, USA.
Thomas Jefferson University Hospital, Health Design Lab, USA.
Am J Otolaryngol. 2023 Nov-Dec;44(6):103963. doi: 10.1016/j.amjoto.2023.103963. Epub 2023 Jun 22.
Mandibular resection and reconstruction are common but complex procedures in head and neck surgery. Resection with adequate margins is critical to the success of the procedure but technical training is restricted to real case experience. Here we describe our experience in the development and evaluation of a mandibular resection and reconstruction simulation module.
3D printed (3DP) models of a mandible with a pathologic lesion were developed from imaging data from a patient with an ameloblastoma. During an educational conference, otolaryngology trainees participated in a simulation in which they reviewed a CT scan of the pathologic mandible and then planned their osteotomies before and after handling a 3DP model demonstrating the lesion. The adequacy of the osteotomy margins was assessed and components of the simulation were rated by participants with pre- and post-training surveys.
52 participants met criteria. After reviewing the CT scan, 34 participants (65.3 %) proposed osteotomies clear of the lesion. This proportion improved to 48 (92.3 %, p = 0.001) after handling the 3D model. Among those with initially adequate margins (n = 33), 45.5 % decreased their margins closer to the ideal, 27.2 % made no revision, 21.2 % widened their margins. 92 % of participants found the simulation beneficial for surgical planning and technical training. After the exercise, the majority of participants had increased confidence in conceptualizing the boundaries of the lesion (69.2 %) and their abilities to ablate (76.5 %).
The structured mandibulectomy simulation using 3DP models was useful in the development of trainee experience in segmental mandible resection.
This study presents the first mandibulectomy simulation module for trainees with the use of 3DP models. The use of a 3DP model was also shown to improve the quality of surgical training.
下颌骨切除和重建是头颈部外科常见但复杂的手术。为了确保手术的成功，充分的切缘是至关重要的，但技术培训仅限于真实病例的经验。在这里，我们描述了我们在开发和评估下颌骨切除和重建模拟模块方面的经验。
从一位患有成釉细胞瘤患者的影像学数据中开发了具有病理病变的下颌骨的 3D 打印（3DP）模型。在一次教育会议上，耳鼻喉科实习生参与了一项模拟，他们首先查看了病理下颌骨的 CT 扫描，然后在处理展示病变的 3DP 模型之前和之后规划他们的截骨术。参与者评估了截骨术边缘的充分性，并通过培训前后的调查对模拟的各个部分进行了评分。
52 名参与者符合标准。在查看 CT 扫描后，34 名参与者（65.3%）提出了避开病变的截骨术。在处理 3D 模型后，这一比例提高到 48 名（92.3%，p=0.001）。在最初具有足够切缘的参与者中（n=33），45.5%的人将切缘缩小到更接近理想的位置，27.2%的人没有修改，21.2%的人扩大了切缘。92%的参与者认为模拟对手术规划和技术培训很有帮助。在练习后，大多数参与者对概念化病变边界的能力（69.2%）和消融病变的能力（76.5%）更有信心。
使用 3DP 模型的结构化下颌骨切除术模拟对于实习生的节段性下颌骨切除术经验的发展是有用的。
本研究首次提出了使用 3DP 模型的下颌骨切除术模拟模块，该模型还提高了手术培训的质量。
