The Larry Tube: Customized 3D Printed Laryngectomy Tubes Following Total Laryngectomy.

OBJECTIVE: To determine whether a custom laryngectomy tube can improve airway symptoms in total laryngectomy patients with atypical anatomy who are unable to use commercial laryngectomy tubes. Furthermore, to exemplify the power of customizable 3D printed medical devices when combined with the expanded access pathway through the FDA. METHODS: A custom-fabricated laryngectomy tube, manufactured at in-house clinical engineering labs, was utilized for each patient following typical laryngectomy tube protocols. All participants had previously undergone a total laryngectomy. Patients were selected based on critical airway obstruction posing potentially life-threatening scenarios while using commercially available laryngectomy tubes. RESULTS: For all patients involved, there were no further airway obstruction complications or events, and they reported a subjective, significant improvement in comfort after placement of the custom laryngectomy tube. CONCLUSION: Custom laryngectomy tubes can provide patients with atypical anatomy relief from airway obstructions and improve comfort when commercial options fail to address the anatomic restriction. The process used to develop custom laryngectomy tubes may be relevant for other diseases and patients with atypical anatomies through the expanded access pathway.

Development of a High-Fidelity, 3D Printed Otoplasty Surgical Simulator.

IMPORTANCE: Prominotia has functional and esthetic impact for the child and family and proficiency in otoplasty requires experiential rehearsal. OBJECTIVES: To design and validate an anatomically accurate, 3D printed prominotia simulator for rehearsal of otoplasties. METHODS: A 3D prominotia model was designed from a computed tomographic (CT) scan and edited in 3-matic software. Negative molds were 3D printed and filled with silicone. Expert surgeons performed an otoplasty procedure on these simulators and provided Likert-based feedback. RESULTS: Six expert surgeons with a mean of 14.3 years of practice evaluated physical qualities, realism, performance, and value of the simulator. The simulator was rated on a scale of 1 (no value) to 5 (great value) and scored 3.83 as a training tool, 3.83 as a competency evaluation tool, and 4 as a rehearsal tool. CONCLUSIONS: Expert validation rated the otoplasty simulator highly in physical qualities, realism, performance, and value. With minor modifications, this model demonstrates valuable educational potential.

A national pediatric otolaryngology fellowship virtual dissection course using 3D printed simulators.

OBJECTIVE: Our objective was to create and evaluate a novel virtual platform dissection course to complement pediatric otolaryngology fellowship training in the setting of the COVID-19 pandemic. METHODS: A four-station, four-simulator virtual course was delivered to pediatric otolaryngology fellows virtually using teleconferencing software. The four stations consisted of microtia ear carving, airway graft carving, cleft lip repair, and cleft palate repair. Fellows were asked to complete pre- and post-course surveys to evaluate their procedural confidence, expertise, and attitudes towards the course structure. RESULTS: Statistical analysis of pre-course survey data showed fellows agreed that simulators should play an important part in surgical training (4.59 (0.62)); would like more options for training with simulators (4.31 (0.88)); and would like the option of saving their simulators for later reference (4.41 (0.85)). Fellows found the surgical simulators used in the course to be valuable as potential training tools (3.96 (0.96)), as competency or evaluation tools (3.91 (0.98)), and as rehearsal tools (4.06 (0.93)). Analysis showed a statistically significant improvement in overall surgical confidence in performing all four procedures. CONCLUSION: This virtual surgical dissection course demonstrates 3D printed surgical simulators can be utilized to teach fellows advanced surgical techniques in a low-risk, virtual environment. Virtual platforms are a viable, highly-rated option for surgical training in the setting of restricted in-person meetings and as a mechanism to increase access for fellows by reducing costs and travel requirements during unrestricted periods.

Translation of Legislation: Effect Analysis of Michigan Opioid Law on Clinical Practice.

BACKGROUND: To combat almost 450,000 Americans dying of opioid overdose between 1999 and 2018, the Michigan Opioid Laws were implemented on July 1, 2018, to reduce overprescription of opioids. This retrospective study evaluated the effect of this legislation on prescribing patterns after thoracic operations at an academic, tertiary care center. METHOD: Charts of 776 patients undergoing lobectomy, paraesophageal hiatal hernia repair, Nissen fundoplication, or esophagectomy between July 1, 2017, and July 1, 2019, were reviewed. Populations were identified before and after the July 1, 2018 implementation of the Michigan Opioid Laws. Procedure type, analgesic type, total pills, morphine equivalents, and refills and their pill number were independent variables. Patients using opioids for >30 days before operations were excluded. RESULTS: Overall, 629 patients were included in the analysis (324 pre-legislation patients, 305 post-legislation patients). The average number of opioids prescribed to patients at discharge before the legislation was 28.0 pills vs 21.4 pills after (P < .01). Before implementation of the Michigan Opioid Laws, 14.5% of patients received refills, whereas only 5.9% received refills after implementation, reducing the average number of refills per patient from 0.19 to 0.07 (P < .001). Average morphine equivalents and percentage of patients receiving opioids showed no statistical difference. CONCLUSIONS: The implementation of the Michigan Opioid Laws correlated with a change in clinical practice, potentially by reducing the number of pills and refills prescribed per patient, and did not deter providers from prescribing opioids acutely. This suggests that the Michigan Opioid Laws allow prescribing freedom while giving legislative structure encouraging time-conscious tapering. The Michigan Opioid Laws may serve as a model for other states to emulate.

Tibial Post Fracture After Total Knee Arthroplasty: Ultrasound as a Viable Diagnostic Tool: A Case Report.

CASE: A 60-year-old woman presented with knee instability and pain that started approximately 13 years after a posterior stabilized total knee arthroplasty. Physical examination revealed significant posterior laxity. Bedside ultrasound (US) documented a free-floating, hyperechoic linear artifact within the posterior knee joint capsule. Revision with liner of increased thickness alleviated presenting symptoms. CONCLUSION: Tibial postfractures often present with instability and pain. Diagnosis of a tibial postfracture can be based on clinical examination; other diagnostics commonly used include arthroscopy or computed tomography/magnetic resonance imaging. US by a qualified sonographer is a potential diagnostic route that should be explored more rigorously.

Early preclinical evaluation of a novel, computer aided designed, 3D printed, bioresorbable posterior cricoid scaffold.

OBJECTIVES: The posterior cricoid split with rib graft is a procedure that elegantly corrects pediatric posterior glottic stenosis and subglottic stenosis. Currently, the procedure requires harvesting of rib cartilage which leaves room for optimization. With use of three dimensional printing technology, our objective was to design a device that would negate the need for costal cartilage harvesting in this procedure. METHODS: An optimized, novel polycaprolactone scaffold was designed using computer aided design software and three dimensional printing. A pilot proof of concept study was conducted with implantation of the device in three porcine animal subjects. Device was evaluated by post-procedural clinical course, endoscopic exams, post-mortem exam, and histological evaluation. RESULTS: A series of variably sized scaffolds were created. The scaffolds showed structural integrity and successfully expanded the cricoid cartilage in the porcine model study. Post-operative endoscopy and clinical exams demonstrated no signs of implant instability or failure. Gross and histologic exams showed successful mucosalization over the scaffold and cartilage ingrowth by six weeks. CONCLUSION: This porcine animal pilot study demonstrated early success of a computer-aided designed, 3D printed, bioresorbable PCL posterior graft scaffold. The scaffolds eliminate the need for costal cartilage harvesting and had excellent surgical usability. The scaffolds functioned as designed, offering proof of concept and grounds for further evaluation to expand on this small pilot study with larger animal studies and continued design refinement.