title: 3D-Printed Simulation Device for Orbital Surgery.
abstract: OBJECTIVE
  Orbital surgery is a challenging procedure because of its complex anatomy. Training could especially benefit from dedicated study models. The currently available devices lack sufficient anatomical representation and realistic soft tissue properties. Hence, we developed a 3D-printed simulation device for orbital surgery with tactual (haptic) correct simulation of all relevant anatomical structures.
  
  
  METHODS
  Based on computed tomography scans collected from patients treated in a third referral center, the hard and soft tissue were segmented and virtually processed to generate a 3D-model of the orbit. Hard tissue was then physically realized by 3D-printing. The soft tissue was manufactured by a composite silicone model of the nucleus and the surrounding tissue over a negative mold model also generated by 3D-printing. The final model was evaluated by a group of 5 trainees in oral and maxillofacial surgery (1) and a group of 5 consultants (2). All participants were asked to reconstruct an isolated orbital floor defect with a titanium implant. A stereotactic navigation system was available to all participants. Their experience was evaluated for haptic realism, correct representation of surgical approach, general handling of model, insertion of implant into the orbit, placement and fixation of implant, and usability of navigated control. The items were evaluated via nonparametric statistics (1 [poor]-5 [good]).
  
  
  RESULTS
  Group 1 gave an average mark of 4.0 (±0.9) versus 4.6 (±0.6) by group 2. The haptics were rated as 3.6 (±1.1) [1] and 4.2 (±0.8) [2]. The surgical approach was graded 3.7 (±1.2) [1] and 4.0 (±1.0) [2]. Handling of the models was rated 3.5 (±1.1) [1] and 4 (±0.7) [2]. The insertion of the implants was marked as 3.7 (±0.8) [1] and 4.2 (±0.8) [2]. Fixation of the implants was also perceived to be realistic with 3.6 (±0.9) [1] and 4.2 (±0.45) [2]. Lastly, surgical navigation was rated 3.8 (±0.8) [1] and 4.6 (±0.56) [2].
  
  
  CONCLUSIONS
  In this project, all relevant hard and soft tissue characteristics of orbital anatomy could be realized. Moreover, it was possible to demonstrate that the entire workflow of an orbital procedure may be simulated. Hence, using this model training expenses may be reduced and patient security could be enhanced.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany. Electronic address: juergen.lichtenstein@gmx.de.
authors.forename: Juergen Thomas
authors.initials: JT
authors.lastname: Lichtenstein
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander Nicolai
authors.initials: AN
authors.lastname: Zeller
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Juliana
authors.initials: J
authors.lastname: Lemound
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Thorsten Enno
authors.initials: TE
authors.lastname: Lichtenstein
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Majeed
authors.initials: M
authors.lastname: Rana
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Nils-Claudius
authors.initials: NC
authors.lastname: Gellrich
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Maximilian Eberhard
authors.initials: ME
authors.lastname: Wagner
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004521:Educational Measurement; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008953:Models, Anatomic; D017145:Models, Educational; D009915:Orbit / Q000033:anatomy & histology / Q000601:surgery*; D009916:Orbital Diseases / Q000601:surgery; D066330:Printing, Three-Dimensional / Q000295:instrumentation*; D019651:Plastic Surgery Procedures / Q000193:education; D000066908:Simulation Training / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; computer-aided design; computer-assisted surgery; orbit; simulation training; three-dimensional printing