Development and use of augmented reality and 3D printing in consulting patient with complex skull base cholesteatoma

Temporal bone and skull base anatomy is complex and can pose difficulties in patient’s perception of disease and anatomy, perceived risks, and complications of surgery. We wish to demonstrate the development and use of augmented reality (AR) technology and three-dimensional (3D) printing to assist in preoperative patient consultation in the case of a complex skull base cholesteatoma. A series of 3D models were constructed from a patient’s petrous temporal bone computed tomography (CT) scans using CAD (computer-aided design) software to display the cholesteatoma affected temporal bone and related structures. Supplementary labels and titles were also created. A two-dimensional (2D) image was created as an AR recognition marker. Both 3D and 2D assets were uploaded, linked in an AR development platform called Hyperspaces which was then published to the Hyperspaces cloud server to build an AR application for free access using a predefined keyword on an iOS mobile device. Patient’s temporal bone was also fabricated through a fused deposition modelling 3D printer using polylactic acid filament for patient consultation. AR and 3D printing allow patient-specific clinical information and complexities to be made readily available to the patient and doctor at low cost, and aid in understanding complex skull base anatomy and progressive disease such as cholesteatoma. The advancement of AR and 3D printing technologies are making complex and patient-specific 3D medical data visualisation feasible and tangible on a mobile device and in hand. Thus, these technologies can be used as an invaluable patient education and counselling tool offering a powerful medium in specialties where difficult anatomical challenges are encountered.Abbreviations: ABS: acrylonitrile–butadiene–styrene; AM: additive manufacturing; AR: augmented reality; CAD: computer-aided design; CT: computed tomography; DICOM: Digital Imaging and Communication in Medicine; FBX: Filmbox; FDM: fused deposition modelling; JPEG: joint photographic experts group; MRI: magnetic resonance imaging; PLA: polylactic acid; ROI: region of interest; STL: Stereolithography