Using 3D printed sinonasal models to visualize and optimize personalized sinonasal sinus irrigation strategies

Abstract

Background: Topical sinus irrigations (neti-pot, squeeze bottles) play a critical role in the management of sinonasal disease.However, due to intricate nasal anatomy, penetration of topical irrigations to targeted sinus regions may be highly variable, and difficult to objectively predict. Variables, including head positions, injection angles, flow rates, etc. may vary significantly depending on the individual's anatomy. Objective:The purpose of this study was to propose a novel idea: using a 3D printed model of sinonasal cavities to visualize and develop a patient-specific irrigation strategy.Methods: As a proof of concept, 3D replicas of one patient's sinonasal cavities pre-and post-surgery were printed with a Form2 SLA 3D printer based on their CT scans. The setup included rubber/silicon seals attached to the model's nostrils to create a watertight seal with the irrigation device and food color dye added for better visualization of irrigation results.Results: Irrigations were performed on the 3D models with various head positions, injection angles, and flow rates, and were successful to determine the optimal strategy to targeted sinuses. Significant differences were observed between different targeted sinuses and between pre and post-surgery models. Conclusion:With more affordable 3D printing, this technology may potentially improve patient care and patient education, allowing clinicians and patients to develop a personalized irrigation strategy and have visual confirmation.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…The head down and forward position appears to be optimal for topical delivery but may be impractical or difficult for those with limited mobility. For high volume devices, proper head position is less critical for solutions to reach the sinuses in the post‐operative state, but to reach the sphenoid sinus consistently, patients will often need to irrigate in the nose‐to‐ceiling position 1278,1279 …”

“…First generation low‐volume devices such as drops, sprays, and nebulizers are an acceptable alternative if nasal cavity or limited sinus delivery is needed, but should not play a significant role in the management of CRSwNP as they do not reliably reach within the sinuses and provide no mechanism for lavage. However, second generation systems using pulsating aerosols or exhalation delivery systems to appear to provide significant deposition of drug to operated sinuses, but do not provide the additional benefit of lavage 1085,1267–1269,1272–1279,1667 …”

Effect of Partial Uncinectomy After Balloon Sinuplasty on Maxillary Sinus Irrigant Penetration: A Cadaveric Study

“…Some authors have used computational fluid dynamics simulations or 3-dimensional printing sinonasal models to evaluate delivery systems. 23 , 34 Further studies involving these technologies are needed to understand the role of partial uncinectomy in the irrigation penetration of the maxillary sinus. Regarding our finding of increased retrograde irrigation of the contralateral maxillary sinus after partial uncinectomy, additional studies based on quantitative measures of this phenomenon would add to our understanding of the benefit of partial uncinectomy with BSP.…”

Rhinology in review: from COVID-19 to biologicals

“…On the other hand, nebulization as delivery system does not seem to give better symptom control than a conventional nasal spray (160) . Some even advocate patient-personalized irrigation strategies based on 3D-printed models of their sinus CT scans (161) .…”