Improving the educational accessibility of sinonasal and skull base anatomy: A novel virtual tool for otolaryngology trainees

Abstract

Background: Understanding the complex three-dimensional (3D) anatomy of the nasal cavity, paranasal sinuses, and skull base, is difficult but essential for otolaryngology trainees, especially for endoscopic techniques. There is no effective teaching tool at the junior resident or medical student level allowing visualization and manipulation of these structures in 3D.

Objective: To create an interactive 3D app modeling the sinus and skull base for use by junior trainees learning surgical anatomy.

Methods: Using Adobe Photoshop, Cinema 4D, and ZBrush, surgeon and medical illustration teams collaborated to develop a tool combining schematic representation of relevant anatomy with radiologic and endoscopic correlates. This was then incorporated into a web application. Twenty-one junior residents and medical students were recruited to use the app, and pre-and post-app self-assessments and experience surveys were conducted to assess didactic efficacy.

Results: We created an online-compatible fully manipulatable schematic 3D representation of the nasal cavity, paranasal sinuses, and anterior skull base that is capable of anatomic layering. This schematic is presented alongside representative de-identified radiologic images and surgical principles with corresponding highlighted diagrammatic structures to demonstrate clinically relevant radiologic and endoscopic anatomy. There was a statistically significant improvement in anatomical knowledge in all 13 questions assessing didactic efficacy, with 85.7% of participants providing overall positive feedback.

Conclusions: Acknowledging the didactic utility in an early validation study with junior trainees, this sinus anatomy teaching tool offers a low-cost and highly accessible modality capable of demonstrating complex anatomical relationships to trainees learning sinus and endoscopic endonasal skull base surgery.

Keywords

3D modeling / anatomy / education / endoscopic endonasal skull base surgery / rhinology / sinus surgery / skull base / surgical education / technology / trainees

References

[1] Zhao J , Xu X , Jiang H , Ding Y . The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies. BMC Med Educ. 2020; 20 (1): 1- 10.

[2] Stull AT , Hegarty M , Mayer RE . Getting a handle on learning anatomy with interactive three-dimensional graphics. J Educ Psychol. 2009; 101 (4): 803- 816.

[3] Greuter L , De Rosa A , Cattin P , Croci DM , Soleman J , Guzman R . Randomized study comparing 3D virtual reality and conventional 2D on-screen teaching of cerebrovascular anatomy. Neurosurg Focus. 2021; 51 (2): 1- 7.

[4] Rapp AK , Healy MG , Charlton ME , Keith JN , Rosenbaum ME , Kapadia MR . YouTube is the most frequently used educational video source for surgical preparation. J Surg Educ. 2016; 73 (6): 1072- 1076.

[5] Ruthberg JS , Quereshy HA , Ahmadmehrabi S , et al. A multimodal multi-institutional solution to remote medical student education for otolaryngology during COVID-19. Otolaryngol Head Neck Surg. 2020; 163 (4): 707- 709.

[6] Goates AJ , Chweya CM , Choby G , Carlson ML . An open-access, comprehensive otolaryngology—head and neck surgery video atlas for resident education. Am J Otolaryngol. 2020; 41 (6): 102628.

[7] Barnes JH , Choby G , Smith AJ , et al. Creation of a new educational podcast: “Headmirror’s ENT in a Nutshell”. Otolaryngol Head Neck Surg. 2020; 163 (4): 623- 625.

[8] Wang H , Merchant SN , Sorensen MS . A downloadable three-dimensional virtual model of the visible ear. ORL J Otorhinolaryngol Relat Spec. 2007; 69 (2): 63- 67.

[9] Bailey CE , Grauer JS , Chen PG , et al. Development of a self-directed sinonasal surgical anatomy video curriculum: phase 1 validation. Int Forum Allergy Rhinol. 2021; 11 (11): 1570- 1576.

[10] Yao WC , Regone RM , Huyhn N , Butler EB , Takashima M . Three-dimensional sinus imaging as an adjunct to two-dimensional imaging to accelerate education and improve spatial orientation. Laryngoscope. 2014; 124 (3): 596- 601.

[11] Barber SR , Jain S , Son YJ , Chang EH . Virtual functional endoscopic sinus surgery simulation with 3D-printed models for mixed-reality nasal endoscopy. Otolaryngol Head Neck Surg. 2018; 159 (5): 933- 937.

[12] Wise S , Orlandi R , DelGaudio J . Sinonasal development and anatomy. In: Kennedy D, Hwang P, eds. Rhinology. 1st ed. Thieme; 2012: 1- 24.

[13] Wang J , Li W , Dun A , Zhong N , Ye Z . 3D visualization technology for learning human anatomy among medical students and residents: a meta- and regression analysis. BMC Med Educ. 2024; 24 (1): 2024426.

[14] Bui I , Bhattacharya A , Wong SH , Singh HR , Agarwal A . Role of three-dimensional visualization modalities in medical education. Front Pediatr. 2021; 9: 760363.

[15] Hendricks BK , Hartman J , Cohen-Gadol AA . Cerebrovascular operative anatomy: an immersive 3D and virtual reality description. Oper Neurosurg. 2018; 15 (6): 613- 623.

[16] Lo S , Abaker ASS , Quondamatteo F , et al. Use of a virtual 3D anterolateral thigh model in medical education: augmentation and not replacement of traditional teaching? J Plast Reconstr Aesthetic Surg. 2020; 73 (2): 269- 275.

[17] Imai T , Tanaka Y , Hatanaka Y , et al. Incorporation of virtual reality in the clinical training of medical students studying esophageal and mediastinal anatomy and surgery. Surg Today. 2022; 52 (8): 1212- 1217.

[18] Schmidt R , Gartrell R , Yeung JM . A pipeline for generating interactive, schematic 3D surgical anatomy models. J Surg Educ. 2021; 78 (5): 1419- 1424.

[19] Ryan ML , Wang S , Pandya SR . Integrating artificial intelligence into the visualization and modeling of three-dimensional anatomy in pediatric surgical patients. J Pediatr Surg. 2024: 161629.

[20] Satapathy P , Hermis AH , Rustagi S , Pradhan KB , Padhi BK , Sah R . Artificial intelligence in surgical education and training: opportunities, challenges, and ethical considerations - correspondence. Int J Surg. 2023; 109 (5): 1544.

[21] Hey G , Guyot M , Carter A , Lucke-Wold B . Augmented reality in neurosurgery: a new paradigm for training. Medicina (B Aires). 2023; 59 (10): 1721.

[22] Park JJ , Tiefenbach J , Demetriades AK . The role of artificial intelligence in surgical simulation. Front Med Technol. 2022; 4: 1076755.

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2024 The Author(s). Eye & ENT Research published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.