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

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.