Evaluating the Use of Cleft Lip and Palate 3D-Printed Models as a Teaching Aid

Three-Dimensional Printing in Surgical Education: An Updated Systematic Review of the Literature

INTRODUCTION

Three-dimensional printing (3DP) is being integrated into surgical practice at a significant pace, from preprocedural planning to procedure simulation. 3DP is especially useful in surgical education, where printed models are highly accurate and customizable. The aim of this study was to evaluate how 3DP is being integrated most recently into surgical residency training.

METHODS

We performed a structured literature search of the OVID/MEDLINE, EMBASE, and PUBMED databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles published from 2016 to 2023 that met predefined inclusion and exclusion criteria were included. Data extracted included surgical subspecialty using 3DP, application of 3DP, and any reported satisfaction measures of trainees. A thorough analysis of pooled data was performed to evaluate satisfaction rates among studies.

RESULTS

A total of 85 studies were included. The median number of participants was 18 (interquartile range 10-27). Fourteen surgical disciplines were represented, with ear, nose, and throat/otolaryngology having the highest recorded utilization of 3DP models among residents and medical students (22.0%), followed by neurosurgery (14.0%) and urology (12.0%). 3DP models were created most frequently to model soft tissue (35.3%), bone (24.7%), vessel (14.1%), mixed (16.4%), or whole organs (6.66%) (Fig.1). Feedback from trainees was overwhelmingly positive regarding the fidelity of the models and their support for integration into their training programs. Among trainees, the combined satisfaction rate with their use in the curriculum was 95% (95% confidence interval, 0.92-0.97), and the satisfaction rate with the model fidelity was 90% (95% confidence interval, 0.86-0.94).

CONCLUSIONS

There is wide variation in the surgical specialties utilizing 3DP models in training. These models are effective in increasing trainee comfort with both common and rare scenarios and are associated with a high degree of resident support and satisfaction. Plastic surgery programs may benefit from the integration of this technology, potentially strengthening future surgical curricula. Objective evaluations of their pedagogic effects on residents are areas of future research.

3D printing materials and 3D printed surgical devices in oral and maxillofacial surgery: design, workflow and effectiveness

Oral and maxillofacial surgery is a specialized surgical field devoted to diagnosing and managing conditions affecting the oral cavity, jaws, face and related structures. In recent years, the integration of 3D printing technology has revolutionized this field, offering a range of innovative surgical devices such as patient-specific implants, surgical guides, splints, bone models and regenerative scaffolds. In this comprehensive review, we primarily focus on examining the utility of 3D-printed surgical devices in the context of oral and maxillofacial surgery and evaluating their efficiency. Initially, we provide an insightful overview of commonly utilized 3D-printed surgical devices, discussing their innovations and clinical applications. Recognizing the pivotal role of materials, we give consideration to suitable biomaterials and printing technology of each device, while also introducing the emerging fields of regenerative scaffolds and bioprinting. Furthermore, we delve into the transformative impact of 3D-printed surgical devices within specific subdivisions of oral and maxillofacial surgery, placing particular emphasis on their rejuvenating effects in bone reconstruction, orthognathic surgery, temporomandibular joint treatment and other applications. Additionally, we elucidate how the integration of 3D printing technology has reshaped clinical workflows and influenced treatment outcomes in oral and maxillofacial surgery, providing updates on advancements in ensuring accuracy and cost-effectiveness in 3D printing-based procedures.

Design and fabrication of silicone cleft lip simulation model for personalized surgical training

PURPOSE OF THE STUDY

To elucidate the design and fabrication methodologies employed in creating a personalized cleft lip simulation model, primarily intended for enhancing surgical training and diverse applications. The study further sought to assess the viability of integrating this simulation model into undergraduate oral experiments and instructional settings.

STUDY DESIGN

Facial data from individuals with cleft lip conditions were acquired using a scanner. Subsequent stages involved reverse engineering and the utilization of 3D printing technology to generate a cleft lip silicone simulation model. The molding process entailed injecting silicone into a polylactic acid mold. The study enrolled 53 undergraduate students majoring in dentistry, who were randomly assigned to either a control or experimental group. A dedicated instructor guided each group independently, employing a combination of multiple-choice tests and surveys to gauge real-time evaluations and discern inter-group disparities.

RESULTS AND CONCLUSIONS

We successfully designed and produced a personalized cleft lip simulation model, demonstrating notable efficacy in the context of cleft lip experimental teaching. Statistical analysis revealed a significant difference (P < 0.05) in the scores of the experimental group students on multiple-choice questions pertaining to cleft lip surgical procedures. Survey outcomes indicated that the experimental group students exhibited higher confidence levels in cleft lip surgery, as reflected from their responses to relevant questions, compared to the traditional group students. These differences were statistically significant (P < 0.05). The simulation model developed in this study emerges as a reliable and cost-effective training and teaching tool for cleft lip surgery.

Application of 3D Printing in Cleft Lip and Palate Repair

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

Bilateral Cleft lip Simulation

OBJECTIVE

To evaluate the features, anatomic accuracy, and educational value of a high-fidelity bilateral cleft lip simulator.

DESIGN

Evaluation of the simulator by expert cleft surgeons after performing a simulated bilateral cleft lip repair.

SETTING

The simulator was evaluated by the surgeons during the Latin American Craniofacial Association meeting.

PARTICIPANTS

Eleven experienced cleft surgeons evaluated the simulator. The cleft surgeons were selected based on their availability during the meeting.

INTERVENTIONS

The participants performed a simulated bilateral cleft lip repair. They were each provided with a questionnaire assessing the simulator's features, realism and value as a training tool.

MAIN OUTCOME MEASURE (S)

The main outcome measure are the scores obtained from a Likert-type questionnaire assessing the simulators features, realism and value.

RESULTS

Overall, the surgeons agreed with the simulator's realism and anatomic accuracy (average score of 3.7 out of 5). Overall, the surgeons strongly agreed with the value of the simulator as a training tool (average score of 4.6 out of 5).

CONCLUSIONS

A high-fidelity bilateral cleft lip simulator was developed that is realistic and valuable as a training tool. The simulator provides a comprehensive training platform to gain hands-on experience in bilateral cleft lip repair before operating on real patients.

Evaluation of a 3D-printed hands-on radius fracture model during teaching courses

OBJECTIVE

This study aimed to evaluate the effectiveness of a 3D-printed hands-on radius fracture model for teaching courses. The model was designed to enhance understanding and knowledge of radius fractures among medical students during their clinical training.

METHODS

The 3D models of radius fractures were generated using CT scans and computer-aided design software. The models were then 3D printed using Fused-Filament-Fabrication (FFF) technology. A total of 170 undergraduate medical students participated in the study and were divided into three groups. Each group was assigned one of three learning aids: conventional X-ray, CT data, or a 3D-printed model. After learning about the fractures, students completed a questionnaire to assess their understanding of fracture mechanisms, ability to assign fractures to the AO classification, knowledge of surgical procedures, and perception of the teaching method as well as the influence of such courses on their interest in the specialty of trauma surgery. Additionally, students were tested on their ability to allocate postoperative X-ray images to the correct preoperative image or model and to classify them to the AO classification.

RESULTS

The 3D models were well received by the students, who rated them as at least equal or better than traditional methods such as X-ray and CT scans. Students felt that the 3D models improved their understanding of fracture mechanisms and their ability to explain surgical procedures. The results of the allocation test showed that the combination of the 3D model and X-ray yielded the highest accuracy in classifying fractures according to the AO classification system, although the results were not statistically significant.

CONCLUSION

The 3D-printed hands-on radius fracture model proved to be an effective teaching tool for enhancing students' understanding of fracture anatomy. The combination of 3D models with the traditional imaging methods improved students' ability to classify fractures and allocate postoperative images correctly.

Two cleft palate simulators of Furlow double-opposing Z- palatoplasty: a comparative study

PURPOSE

This study aimed to evaluate the efficiency of the porcine tongue for palatoplasty simulation compared to 3D-printed simulators and their surgical education role.

MATERIALS AND METHODS

A total of 18 senior cleft surgeons participated in a palatoplasty simulation-based workshop conducted using porcine tongue simulators and 3D-printed simulators. This workshop consisted of a didactic session followed by a hands-on simulation session. Each participant independently used both simulators to perform Furlow double-opposing Z-plasty, which was assessed and scored by senior cleft surgeons using a scoring system including organizational flexibility and ductility, anatomical design simulation, proper incision, proper suturing, and convenience of operation. A paired t test was used for data statistical analysis and a P value < 0.05 was regarded as a statistically significant difference.

RESULTS

All senior cleft surgeons strongly agreed that the simulation-based workshop was a valuable learning experience, and both simulators were useful and easy to manipulate (P = 1.00). The results of this comparative study showed that a porcine tongue palatoplasty simulator had an effectively significant difference in terms of organizational flexibility and ductility (P = 0.04), and suturing was better than the 3D-printed palatoplasty simulator (P < 0.01). There were no significant differences between the simulators regarding anatomical design simulation (P = 0.76) and incision simulation (P = 0.65).

CONCLUSION

Both porcine tongue simulator and 3D-printed simulator have their unique strengths in surgical education for palatoplasty. Thus, the combined use of a porcine tongue and a 3D-printed cleft palate simulators are efficient as an educational model to practice Furlow double-opposing Z- palatoplasty. The porcine tongue simulators are superior in terms of organizational flexibility, ductility, and suturing simulators, while with the 3D-printed simulator, various palatoplasty techniques can be repeatedly practiced with better-simulated face and oral cavity.

Effect of teaching tools in spatial understanding in health science education: a systematic review

Background

The concept of spatial orientation is integral to health education. Students studying to be healthcare professionals use their visual intelligence to develop 3D mental models from 2D images, like X-rays, MRI, and CT scans, which exerts a heavy cognitive load on them. Innovative teaching tools and technologies are being developed to improve students' learning experiences. However, the impact of these teaching modalities on spatial understanding is not often evaluated. This systematic review aims to investigate current literature to identify which teaching tools and techniques are intended to improve the 3D sense of students and how these tools impact learners' spatial understanding.

Methods

The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed for the systematic review. Four databases were searched with multiple search terms. The articles were screened based on inclusion and exclusion criteria and assessed for quality.

Results

Nineteen articles were eligible for our systematic review. Teaching tools focused on improving spatial concepts can be grouped into five categories. The review findings reveal that the experimental groups have performed equally well or significantly better in tests and tasks with access to the teaching tool than the control groups.

Conclusion

Our review investigated the current literature to identify and categorize teaching tools shown to improve spatial understanding in healthcare professionals. The teaching tools identified in our review showed improvement in measured, and perceived spatial intelligence. However, a wide variation exists among the teaching tools and assessment techniques. We also identified knowledge gaps and future research opportunities.

Using three-dimensional printed models for trainee orbital fracture education

BACKGROUND

Three-dimensional printing is an underutilized technology in ophthalmology training; its use must be explored in complex educational scenarios. This study described a novel approach to trainee education of orbital fracture repair utilizing three-dimensional (3D) printed models as a teaching tool.

METHODS

Ophthalmology residents and oculoplastic fellows from multiple training institutions underwent an educational session on orbital fractures, learning through four different models. Participants analyzed orbital fractures through computerized tomography (CT) imaging alone and then utilizing CT imaging with the aid of a 3D printed model. Participants completed a questionnaire assessing their understanding of the fracture pattern and surgical approach. After the training, participants were surveyed on the impact of the educational session. Components of the training were rated by participants on a 5-point Likert scale.

RESULTS

A statistically significant difference (p < .05) was found in participant confidence conceptualizing the anatomic boundaries of the fracture and planning the orbital fracture approach for repair of three out of four models on pre-test post-test analysis. On exit questionnaire, 84.3% of participants thought the models were a useful tool for surgical planning, 94.8% of participants thought the models were a useful tool for conceptualizing the anatomic boundaries of the fracture, 94.8% of participants thought the models were a useful tool for orbital fracture training, and 89.5% of participants thought the exercise was helpful.

CONCLUSION

This study supports the value of 3D printed models of orbital fractures as an effective tool for ophthalmology trainee education to improve understanding and visualization of complex anatomical space and pathology. Given the limited opportunities trainees may have for hands-on orbital fracture practice, 3D printed models provide an accessible way to enhance training.

Application of additional three-dimensional materials for education in pediatric anatomy

We conducted this study to investigate the effects of additional education using 3D visualization (3DV) and 3D printing (3DP) after applying 2D images for anatomical education in normal pediatric structures and congenital anomalies. For the production of 3DV and 3DP of the anatomical structures, computed tomography (CT) images of the four topics (the normal upper/lower abdomen, choledochal cyst, and imperforate anus) were used. Anatomical self-education and tests were administered to a total of 15 third-year medical students with these modules. Following the tests, surveys were conducted in order to evaluate satisfaction from students. In all four topics, there were significant increases in the test results with additional education with 3DV after initial self-study with CT (P < 0.05). The difference in scores was highest for the imperforate anus when 3DV supplemented the self-education. In the survey on the teaching modules, the overall satisfaction scores for 3DV and 3DP were 4.3 and 4.0 out of 5, respectively. When 3DV was added to pediatric abdominal anatomical education, we found an enhancement in understanding of normal structures and congenital anomalies. We can expect the application of 3D materials to become more widely used in anatomical education in various fields.

Three-dimensional Medical Printing and Associated Legal Issues in Plastic Surgery: A Scoping Review

Three-dimensional printing (3DP) represents an emerging field of surgery. 3DP can facilitate the plastic surgeon's workflow, including preoperative planning, intraoperative assistance, and postoperative follow-up. The broad clinical application spectrum stands in contrast to the paucity of research on the legal framework of 3DP. This imbalance poses a potential risk for medical malpractice lawsuits. To address this knowledge gap, we aimed to summarize the current body of legal literature on medical 3DP in the US legal system. By combining the promising clinical use of 3DP with its current legal regulations, plastic surgeons can enhance patient safety and outcomes.

Efficacy of three-dimensional models for medical education: A systematic scoping review of randomized clinical trials

To estimate the efficacy of three-dimensional (3D) models for medical education.

METHODS

A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted.

RESULTS

Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced.

CONCLUSIONS

Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.

Effectiveness of 3D-printed models prepared from radiological data for anatomy education: A meta-analysis and trial sequential analysis of 22 randomized, controlled, crossover trials

BACKGROUND

Many academicians suggested the supplementary use of 3D-printed models reconstructed from radiological images for optimal anatomy education. 3D-printed model is newer technology available to us. The purpose of this systematic review was to capture the usefulness or effectiveness of this newer technology in anatomy education.

MATERIALS AND METHODS

Twenty-two studies met the inclusion and exclusion criteria for quantitative synthesis. The included studies were sub-grouped according to the interventions and participants. No restrictions were applied based on geographical location, language and publication years. Randomized, controlled trial, cross-sectional and cross-over designs were included. The effect size of each intervention in both participants was computed as a standardized mean difference (SMD).

RESULTS

Twenty-two randomized, controlled trials were included for quantitative estimation of effect size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect size for 3D-printed model was 0.77 (0.45-1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08-4.54, 95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6 studies. The estimated effect size was 2.00 (0.69-3.32, 95% CI, P = 0.003) with significant heterogeneity.

CONCLUSION

The participants exposed to the 3D-printed model performed better than participants who used traditional methodologies. Thus, the 3D-printed model is a potential tool for anatomy education.

Three-dimensional printing models improves long-term retention in medical education of pathoanatomy: A randomized controlled study

INTRODUCTION

Craniosynostosis is a rare and complex pathology, and visuospatial skills are necessary for a good understanding of the condition. While the use of three-dimensional (3D) models has improved the understanding of complex craniofacial anatomy, no study has evaluated the impact of this teaching support on long-term retention.

MATERIALS AND METHODS

Our randomized controlled trial was designed to compare the long-term retention of information with 3D-printed models of four types of craniosynostosis versus classic 3D reconstructions displayed in two-dimensional (2D) among undergraduate students. All students benefited from the same standardized course followed by the manipulation of the learning tool associated with the group for 15 minutes. Long-term retention was assessed by the capability to properly recognize different types of craniosynostosis 3 weeks after the course.

RESULTS

Eighty-five students were enrolled. Previous educational achievements and baseline visuospatial skills were similar between the groups. The bivariate analysis showed the mean score in the 3D and 2D groups were 11.32 (2.89) and 8.08 (2.81), respectively (p < 0.0001).

CONCLUSIONS

3D-printed models of structures with spatial complexity such as various craniosynostosis patterns improve significantly medical students' long-term retention, indicating their educational efficacy.

Three-Dimensional Printing Model Enhances Craniofacial Trauma Teaching by Improving Morphologic and Biomechanical Understanding: A Randomized Controlled Study

BACKGROUND

Teaching about craniofacial traumas is challenging given the complexity of the craniofacial anatomy and the necessity for good spatial representation skills. To solve these problems, three-dimensional printing seems to be an appropriate educative material. In this study, the authors conducted a randomized controlled trial. The authors' main objective was to compare the performance of the undergraduate medical students in an examination based on the teaching support: three-dimensionally printed models versus two-dimensional pictures.

METHODS

All participants were randomly assigned to one of two groups using a random number table: the three-dimensionally-printed support group (three-dimensional group) or the two-dimensionally-displayed support group (two-dimensional group). All participants completed a multiple-choice question evaluation questionnaire on facial traumatology (first, a zygomatic bone fracture; then, a double mandible fracture). Sex and potential confounding factors were evaluated.

RESULTS

Four hundred thirty-two fifth-year undergraduate medical students were enrolled in this study. Two hundred six students were allocated to the three-dimensional group, and 226 were allocated to the two-dimensional group. The three-dimensionally printed model was considered to be a better teaching material compared with two-dimensional support. The global mean score was 2.36 in the three-dimensional group versus 1.99 in the two-dimensional group (p = 0.008). Regarding teaching of biomechanical aspects, three-dimensionally-printed models provide better understanding (p = 0.015). Participants in both groups exhibited similar previous student educational achievements and visuospatial skills.

CONCLUSIONS

This prospective, randomized, controlled educational trial demonstrated that incorporation of three-dimensionally-printed models improves medical students' understanding. This trial reinforces previous studies highlighting academic benefits in using three-dimensionally-printed models mostly in the field of understanding complex structures.

Alternatives in Education-Evaluation of Rat Simulators in Laboratory Animal Training Courses from Participants' Perspective

In laboratory animal science (LAS) education and training, five simulators are available for exercises on handling and routine procedures on the rat, which is-beside mice-the most commonly used species in LAS. Since these simulators may have high potential in protecting laboratory rats, the aim of this study is to investigate the simulators' impact on the 3R (replace, reduce, refine) principle in LAS education and training. Therefore, the simulators were evaluated by 332 course participants in 27 different LAS courses via a practical simulator training workshop and a paper-based two-part questionnaire-both integrated in the official LAS course schedule. The results showed a high positive resonance for simulator training and it was considered especially useful for the inexperienced. However, the current simulators may not completely replace exercises on live animals and improvements regarding more realistic simulators are demanded. In accordance with literature data on simulator-use also in other fields of education, more research on simulators and new developments are needed, particularly with the aim for a broad implementation in LAS education and training benefiting all 3Rs.

Emerging simulation technologies in global craniofacial surgical training

The last few decades have seen an exponential growth in the development and adoption of novel technologies in medical and surgical training of residents globally. Simulation is an active and innovative teaching method, and can be achieved via physical or digital models. Simulation allows the learners to repeatedly practice without the risk of causing any error in an actual patient and enhance their surgical skills and efficiency. Simulation may also allow the clinical instructor to objectively test the ability of the trainee to carry out the clinical procedure competently and independently prior to trainee's completion of the program. This review aims to explore the role of emerging simulation technologies globally in craniofacial training of students and residents in improving their surgical knowledge and skills. These technologies include 3D printed biomodels, virtual and augmented reality, use of google glass, hololens and haptic feedback, surgical boot camps, serious games and escape games and how they can be implemented in low and middle income countries. Craniofacial surgical training methods will probably go through a sea change in the coming years, with the integration of these new technologies in the surgical curriculum, allowing learning in a safe environment with a virtual patient, through repeated exercise. In future, it may also be used as an assessment tool to perform any specific procedure, without putting the actual patient on risk. Although these new technologies are being enthusiastically welcomed by the young surgeons, they should only be used as an addition to the actual curriculum and not as a replacement to the conventional tools, as the mentor-mentee relationship can never be replaced by any technology.

In-house 3D printing: Why, when, and how? Overview of the national French good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery

3D-printing is part of the daily practice of maxillo-facial surgeons, stomatologists and oral surgeons. To date, no French health center is producing in-house medical devices according to the new European standards. Based on all the evidence-based data available, a group of experts from the French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (Société Française de Chirurgie Maxillofaciale, Stomatologie et Chirurgie Orale, SFSCMFCO), provide good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. Briefly, technical considerations related to printers and CAD software, which were the main challenges in the last ten years, are now nearly trivial questions. The central current issues when planning the implementation of an in-house 3D-printing platform are economic and regulatory. Successful in-house 3D platforms rely on close collaborations between health professionals and engineers, backed by regulatory and logistic specialists. Several large-scale academic projects across France will soon provide definitive answers to governance and economical questions related to the use of in-house 3D printing.

[Comprehensive review of 3D printing use in medicine: Comparison with practical applications in urology]

INTRODUCTION

Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications.

METHODS

In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database.

RESULTS

Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training.

CONCLUSION

3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Three-Dimensional Printing in Cleft Care: A Systematic Review

OBJECTIVE

To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications.

DESIGN

Retrospective systematic review.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate.

MAIN OUTCOME MEASURES

Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes.

RESULTS

Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles.

CONCLUSION

3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

Systematic review of three-dimensional printing for simulation training of interventional radiology trainees

RATIONALE AND OBJECTIVES

Three-dimensional (3D) printing has been utilized as a means of producing high-quality simulation models for trainees in procedure-intensive or surgical subspecialties. However, less is known about its role for trainee education within interventional radiology (IR). Thus, the purpose of this review was to assess the state of current literature regarding the use of 3D printed simulation models in IR procedural simulation experiences.

MATERIALS AND METHODS

A literature query was conducted through April 2020 for articles discussing three-dimensional printing for simulations in PubMed, Embase, CINAHL, Web of Science, and the Cochrane library databases using key terms relating to 3D printing, radiology, simulation, training, and interventional radiology.

RESULTS

We identified a scarcity of published sources, 4 total articles, that appraised the use of three-dimensional printing for simulation training in IR. While trainee feedback is generally supportive of the use of three-dimensional printing within the field, current applications utilizing 3D printed models are heterogeneous, reflecting a lack of best practices standards in the realm of medical education.

CONCLUSIONS

Presently available literature endorses the use of three-dimensional printing within interventional radiology as a teaching tool. Literature documenting the benefits of 3D printed models for IR simulation has the potential to expand within the field, as it offers a straightforward, sustainable, and reproducible means for hands-on training that ought to be standardized.

Three-dimensional Printing in Plastic Surgery: Current Applications, Future Directions, and Ethical Implications

Background

Three-dimensional printing (3DP) is a rapidly advancing tool that has revolutionized plastic surgery. With ongoing research and development of new technology, surgeons can use 3DP for surgical planning, medical education, biological implants, and more. This literature review aims to summarize the currently published literature on 3DP's impact on plastic surgery.

Methods

A literature review was performed using Pubmed and MEDLINE from 2016 to 2020 by 2 independent authors. Keywords used for literature search included 3-dimensional (3D), three-dimensional printing (3DP), printing, plastic, surgery, applications, prostheses, implants, medical education, bioprinting, and preoperative planning. All studies from the database queries were eligible for inclusion. Studies not in English, not pertaining to plastic surgery and 3DP, or focused on animal data were excluded.

Results

In total, 373 articles were identified. Sixteen articles satisfied all inclusion and exclusion criteria, and were further analyzed by the authors. Most studies were either retrospective cohort studies, case reports, or case series and with 1 study being prospective in design.

Conclusions

3DP has consistently shown to be useful in the field of plastic surgery with improvements on multiple aspects, including the delivery of safe, effective methods of treating patients while improving patient satisfaction. Although the current technology may limit the ability of true bioprinting, research has shown safe and effective ways to incorporate biological material into the 3D printed scaffolds or implants. With an overwhelmingly positive outlook on 3DP and potential for more applications with updated technology, 3DP shall remain as an effective tool for the field of plastic surgery.

Usefulness of a 3D-Printed Thyroid Cancer Phantom for Clinician to Patient Communication

BACKGROUND

Thyroid glands and surrounding structures are very complex, and this complexity can pose a challenge for clinicians when explaining and communicating to the patient the details of a proposed surgery for thyroid cancer. A three-dimensional (3D) thyroid cancer model could help and improve this communication.

METHODS

A 3D-printed phantom of a thyroid gland and its presenting cancer was produced from segmented head and neck contrast-enhanced computed tomography (CT) data from a patient with thyroid cancer. The phantom reflects the complex anatomy of the arteries, veins, nerves, and other surrounding organs, and the printing materials and techniques were adjusted to represent the texture and color of the actual structures. Using this phantom, patients and clinicians completed surveys on the usefulness of this 3D-printed thyroid cancer phantom.

PARTICIPANTS

patients (n = 33) and clinicians (n = 10).

RESULTS

In the patient survey, the patients communicated that the quality of understanding of their thyroid disease status was enhanced when clinicians explained using the phantom. The clinicians communicated that the 3D phantom was advantageous for explaining complex thyroid surgery procedures to patients, and that the 3D phantom was helpful in educating patients with relatively poor anatomical knowledge.

CONCLUSIONS

Using 3D printing technology, we produced a CT-based 3D thyroid cancer phantom, and patient and clinician surveys on its utility indicated that it successfully helped educate patients, providing them with an improved understanding of the disease.

Three-Dimensional Affordable Stone Models for Cleft Lip Markings: A Prospective Study of Learner Satisfaction

INTRODUCTION

Knowledge of surgical markings for unilateral cleft lip (UCL) repair is critical for surgical competency. However, few appropriate models are accessible to residents and affordable and accurately reproduce this 3-dimensional (3D) deformity. We propose that cleft care units have the capability of creating affordable 3D stone models to teach UCL markings.

METHODS

Polyvinyl siloxane and SnapStone were used to create UCL stone models. Thirteen plastic surgery residents were prospectively recruited, provided with a textbook chapter and online module for studying surgical markings for UCL repair, and then asked to perform the markings on a UCL stone model and standardized patient photograph. Learner satisfaction was evaluated using a modified survey based on the Student Evaluation of Educational Quality survey.

RESULTS

The production time of each model was 10 minutes, whereas the cost was $1.84. Participants reported that the stone model was more stimulating (4.77 ± 0.44 vs 3.92 ± 0.86; U = 38.0; P = 0.008), increased their interest more (4.70 ± 0.48 vs 3.53 ± 1.20; U = 33.5; P = 0.005), allowed better learning (4.61 ± 0.51 vs 3.08 ± 0.86; U = 10.0; P < 0.001), was clearer (4.62 ± 0.51 vs 3.15 ± 0.90; U = 12.5; P < 0.001), and was more effective for learning cleft lip markings (4.77 ± 0.44 vs 3.08 ± 1.04; U = 9.0; P < 0.001). They were also more likely to recommend it (4.85 ± 0.38 vs 3.15 ± 1.07; U = 7.0; P < 0.001).

CONCLUSIONS

Plastic surgery residents report that 3D cleft lip stone models are superior training tools to learn cleft lip markings compared with patient photographs. These educational tools have the potential to overcome significant financial, logistic, and time constraints in teaching cleft lip surgery markings.

Modeling Medical Education: The Impact of Three-Dimensional Printed Models on Medical Student Education in Plastic Surgery

PURPOSE

Trainee exposure to craniofacial pathology can be limited due to rare disease presentation, revealing a need for tools that assist in visualizing complex 3D pathologic anatomy. 3D-printed models show potential as a useful aid, allowing for physical manipulation and hands-on experience. This study investigates their educational value in teaching craniofacial pathology and surgical repair.

METHODS

Forty-four medical students randomly assigned to a control group or model group were given a PowerPoint presentation-based module on craniosynostosis and surgical repair. The model group was also provided with 3D-printed models of sagittal, metopic, and bicoronal synostosis, created using patient-specific preoperative computed tomography data. A survey using the Likert scale evaluated participants' learning experience. Pre- and postmodule scores on a 10-question multiple choice quiz were recorded.

RESULTS

The survey showed that students in the model group reported better understanding of the anatomy (4.86 ± 0.15 versus 4.26 ± 0.22; P = 0.0001) and visualization of the pathology (4.76 ± 0.23 versus 4.26 ± 0.25; P = 0.0064), gaining an improved understanding of surgical approach (4.38 ± 0.37 versus 3.83 ± 0.29; P = 0.0266), which was more effectively taught (4.24 ± 0.33 versus 3.30 ± 0.38; P = 0.0007) with the 3D-printed models. The mean pre- and post-module quiz scores between groups were similar.

CONCLUSION

3D-printed models demonstrated an improved learning experience for medical students as shown by survey. These findings suggest a potential use for 3D-printed models in medical education of craniofacial pathology and surgery.

What Is the Role of 3D Printing in Undergraduate Anatomy Education? A Scoping Review of Current Literature and Recommendations

INTRODUCTION

Three-dimensional (3D)-printed models have become increasingly popular as an alternative to the traditional method of cadaveric dissection in teaching anatomy. It has the advantage of lower cost and higher reproducibility. It has been widely used in the postgraduate setting, but its efficacy in undergraduate education has not been studied extensively.

OBJECTIVES

A scoping review of the literature was undertaken systematically to investigate the role of 3D printing in the anatomy education of undergraduate medical students.

METHODS

A systematic literature search of databases (EMBASE, Pubmed, Educational Resources Information Center, British Education Index and Australian Education Index) was undertaken using relevant keywords.

RESULTS

The search yielded 83 results, which were narrowed down to 13 articles after application of exclusion criteria. The literature supported that 3D printing was a useful tool for studying normal, uncommon and pathological anatomy. However, limitations include low fidelity in replicating the colour and textural physical properties of soft tissues and the trade-off between cost and fidelity.

CONCLUSIONS

It is believed that 3D printing would increasingly be integrated into undergraduate anatomy education, and it might also potentially be used in the assessment of anatomical knowledge and clinical skills training. The establishment of an online 3D model database may facilitate educators to easily manufacture models for specific educational purposes.

3D Printing Technology Improves Medical Interns' Understanding of Anatomy of Gastrocolic Trunk

OBJECTIVE

Complex vascular anatomy has always been a difficult point for medical students. Gastrocolic trunk (Henle trunk) has many branches and variations, involving the venous reflux of the stomach, right colon, and pancreas. This study investigated the effects of 3 dimensional (3D) printing technology on medical interns' understanding of Henle trunk's variation, by comparing 2 dimensional (2D) images.

SETTING

Henle trunk modes were manufactured using 3D-CT angiography and 3D-printing technology.

PARTICIPANTS

Forty-seven interns from 2 medical schools (Nanjing Medical University and Medical College of Nantong University) participated in the study.

DESIGN

The interns were divided randomly allocated into 2 groups, where group 1 was the control group with a 2D image of Henle trunk plus surgical video (named 2D image group), and group 2 was the study group with a 3D printed model of Henle trunk plus surgical video (named 3D-printing group). Knowledge of interns on the Henle trunk was compared between 2 groups using a question test before and after the teaching intervention.

RESULTS

All interns had an improved overall assessment score as a result of attending the seminar, whether in the 2D image group or the 3D-printing group. The score of the 2D image group increased 32.57 ± 13.86, and the 3D-printing group increased 47.04 ± 12.99, showing significant difference (p = 0.001). There was no significant difference observed between postseminar scores between 2 medical schools (p = 0.975). There was a significant improvement in satisfaction among the 3D-printing group for education depth, novel and inspiring of teaching method, except for the interaction between teacher and interns (p = 0.215). Interns hope to have more teaching time for 3D printing, and not satisfied with the time of 3D printing teaching compared with those in the 2D image group (p = 0.021).

CONCLUSIONS

The 3-D printed Henle trunk model is a very effective teaching tool, which can help interns understand the anatomy of Henle trunk. The application of 3D printing technology in the teaching of interns of complex vascular anatomy is worth popularizing in teaching hospitals.

A novel method for fabricating nasoalveolar molding appliances for infants with cleft lip and palate using 3-dimensional workflow and clear aligners

INTRODUCTION

Nasoalveolar molding (NAM) was introduced over 20 years ago as adjunctive therapy for the correction of cleft lip and palate. In the current study, we propose a new approach using a digital workflow and 3-dimensional printing to fabricate clear aligner NAM devices.

METHODS

A polyvinyl siloxane (PVS) impression of an infant with a unilateral complete cleft lip and palate (UCLP) is acquired and poured, and the stone model is scanned with an intraoral scanner. The stereolithography file is digitized, and the alveolar segments are digitally segmented and moved to the desired final position. The total distance moved is divided into a sequence of 1-1.5 mm increments, creating a series of digital models. The models are 3-dimensionally printed along with button templates to allow free form positioning of the button on each model. A Vacuform machine (Taglus, Mumbai, India) was used to fabricate a 0.040-in aligner for each stage.

RESULTS

We present 1 case that was treated successfully with this approach. Appointments for the NAM adjustments were primarily to monitor progress and counseling with less time spent adjusting the appliance. The appointment length was reduced by over 30 minutes. Benefits of the aligner are improved fit, more precise increments of activation, reduced chairside time, and potentially minimized number of visits.

CONCLUSIONS

NAM custom aligners may provide similar benefits to the traditional approach while reducing the burden of care by reducing the number of visits and appointment duration. Further studies with a sample and longitudinal observations are needed to investigate the benefits of the proposed digital approach.

Three-Dimensional Printing of Prenatal Ultrasonographic Diagnosis of Cleft Lip and Palate: Presenting the Needed "Know-How" and Discussing Its Use in Parental Education

Parental prenatal counseling is of paramount significance since parents often experience an emotional crisis with feelings of disappointment and helplessness. Three-dimensional (3D) printed model of the unborn child's face presenting with cleft lip and palate, based on ultrasonographic information, could be used to provide visual 3D information, further enhancing the prospective parent's comprehension of their unborn child's pathology and morphology, helping them to be psychologically prepared and improving the communication with the caretaking team. Prospective parents appreciate if prenatal counseling is available with the most detailed information as well as additional resources. The technique necessary to create 3D models after ultrasonographic information is explained, and the related costs are evaluated. The use of such models in parental education is then discussed.

A Practical Cleft Palate Training Model

Educational models are essential for training surgeons and making them familiar with experience- and skill-dependent operations such as cleft palate closure. The development of computer and 3D printer technology has allowed cleft lip and palate models to be produced and used for surgical training. However, these technology-dependent models are not affordable and reproducible for surgeons in developing countries where cleft cases are more commonly seen. Thus, we aimed to create a cleft palate educational model prepared with play-dough and latex. The play-dough is shaped in the form of a palate and the cleft is created by scissors. Then, a latex glove is cut and applied to the dough to mimic the mucosal layer. The combination of the latex glove and play-dough lets the trainee perform surgical markings, incisions, elevation of the flaps, and layer closure. We think this easily producible model might be beneficial for demonstrating cleft types, surgical techniques, and improving surgical skills, especially in developing countries.

[3D printing in orthopedic and trauma surgery education and training : Possibilities and fields of application]

The 3D printing technology enables precise fracture models to be generated from volumetric digital imaging and communications in medicine (DICOM) computed tomography (CT) data. Apart from patient treatment, in the future this technology could potentially play a significant role in education and training in the field of orthopedic and trauma surgery. Preliminary results show that the understanding and classification of fractures can be improved when teaching medical students. The use of life-size and haptic models of real fractures for education is particularly interesting. Even experienced surgeons show an improved classification and treatment planning with the help of 3D printed models when compared to plain CT data. Especially for complex articular fractures, such as those of the acetabulum and tibial plateau, initial evidence shows patient benefits in terms of reduced surgery time and blood loss with the help of 3D models. The use of 3D printing on-site at the hospital is of particular interest in orthopedic and trauma surgery as it promises to provide products within a short time. The low investment and running costs and the increasing availability of convenient software solutions will spur increasing dissemination of this technology in the coming years.

Application of three-dimensional reconstruction and printing as an elective course for undergraduate medical students: an exploratory trial

BACKGROUND

Medical three-dimensional (3D) digital reconstruction and printing have become common tools in medicine, but few undergraduate medical students understand its whole process and teaching and clinical application. Therefore, we designed an elective course of 3D reconstruction and printing for students and studied its significance and practicability.

METHODS

Thirty undergraduate medical students in their second-year of study volunteered to participate in the course. The course started with three lessons on the theory of 3D digital reconstruction and printing in medicine. The students were then randomly divided into ten groups. Each group randomly selected its own original data set, which could contain a series of 2D images including sectional anatomical images, histological images, CT and MRI. Amira software was used to segment the structures of interest, to 3D reconstruct them and to smooth and simplify the models. These models were 3D printed and post-processed. Finally, the 3D digital and printed models were scored, and the students produced brief reports of their work and knowledge acquisition and filled out an anonymous questionnaire about their study perceptions.

RESULTS

All the students finished this course. The average score of the 30 students was 83.1 ± 2.7. This course stimulated the students' learning interest and satisfied them. It was helpful for undergraduate students to understand anatomical structures and their spatial relationship more deeply. Students understood the whole process of 3D reconstruction and printing and its teaching and clinical applications through this course.

CONCLUSION

It is significant and necessary to develop this course for undergraduate medical students.