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JOÃO F. NOGUEIRA

Hospital Geral de Fortaleza

Sinus Centro

Email: joaoflavioce@hotmail.com

Phone: 55 85 8152-2322

Website: www.sinuscentro.com.br

Introduction: Endoscopic middle ear surgery

is a current “hot topic” in our specialty. The use

of endoscopes in middle ear surgery has

shown new anatomical structures and novel

ventilation theories that may help in the future

of ear surgery. The anatomy of the temporal

bone is considered to be among the most

complex structures in the human body.

Tridimensional (3D) stereoscopic endoscopic

images may allow a better understanding of

these important structures. Objectives: 1) to

demonstrate stereoscopic 3D endoscopic

images of the middle ear and mastoid

anatomy; 2) to demonstrate how to acquire and

generate these 3D images with simple

equipments and a freeware software,

discussing the technical difficulties in the

acquisition and edition of these images.

Method: 5 human heads were dissected. Two

endoscopic images of the same structure were

taken to create 3D images. Results: We

created good quality stereoscopic 3D

endoscopic images of the middle ear and

mastoid anatomy. Conclusions: 3D

stereoscopic endoscopic images were

acquired with low cost equipment, without

great difficulty.

Stereoscopic 3D Endoscopic Images of Middle Ear Anatomy João Flávio Nogueira, MD1; Daniel Nogueira Cruz, MD1; Daniele Marchioni, MD2;

Livio Presutti, MD2; Dave Pothier, MD3; Muaaz Tarabichi, MD4 1Sinus & Oto Centro – Hospital Geral de Fortaleza, Brazil; 2University Hospital of Modena, Italy; 3University of Toronto, Canada; 4American Hospital, Dubai, UAE

We obtained high-quality 2D digital images containing 6-megapixel

resolution. After editing and using proper computer program, we created

excellent 3D stereoscopic images (Figures 1,2,3,4,5,6).

Five human heads were dissected using traditional instruments and a

traditional protocol of endoscopic middle ear dissection (available at

www.sinuscentro.com.br). Two digital images of each anatomic

landmark were captured using a digital camera (SONY Cyber-Shot

DSC-W50 with 6.0-megapixel resolution). The anatomic landmarks were

chosen based on: 1) functional and anatomical importance. 2)

Sequence usually found in endoscopic middle ear surgeries.

Two different pictures of the same image were captured for stereoscopic

formation moving the endoscope in horizontal plan, without specific

support. A distance varying from 10 up to 20 mm was used.

The camera was directly connected to the endoscope with a special

coupler. The images obtained were used to make 3D stereoscopic

images (anaglyphic) in proper computer program Callipygian 3D 2.9

version, which may be found free of charge on Internet at the following

electronic address: http://www.callipygian.com/3D.

With a simple digital camera and free computer program, we obtain 3D

stereoscopic endoscopic images of the middle ear and mastoid with

high quality.

Such images were obtained with low cost and few technical difficulties

and its use may improve the anatomic knowledge of ENTs residents as

well as medical doctors.

Endoscopic middle ear surgery is a current “hot topic” in our specialty.

The use of endoscopes in middle ear surgery has shown new

anatomical structures and novel ventilation theories that may help

understand the physiology of inflammatory middle ear diseases and

also develop new surgical techniques for the future of ear surgery.

We live in a physically tridimensional (3D) world, but our teaching and

documentation techniques are essentially based on the use of oral and

written language in bidimensional (2D) reproductions1.

The complexity and richness of 3D details of the surgical anatomy of the

middle ear and mastoid makes otologists need to know it deeply before

starting surgical practice1,2. Nervous, vascular and other structures are

closely related, sometimes separated just by a few millimeters.

The inter-related structures, the several plans and deepness make the

anatomic teaching difficult to understand, mainly when classically

demonstrated in anatomy books or 2D theoretical classes3,4,5,6,7,8.

The 3D stereoscopic images, once they provide deepness perception,

may allow a better knowledge and understanding of the important

relations between the structures of the nose, PNS and skull base3,4,7,8.

Traditionally, 3D stereoscopic images, that is, the ones which contain

clear deepness perception, may be obtained through three basic

methods: parallel, polarized or anaglyphic.

Each method has its peculiarities, advantages and disadvantages, but

all of them basically need special equipment to capture and

project/demonstrate: such as proper cameras, specific supports,

glasses, projectors or special screens.

Such equipment is frequently unavailable to most Brazilian institutions

due to the high financial cost, being also equipment which is difficult to

maintain and manage8.

The objectives of this project are: 1) to show 3D stereoscopic

endoscopic images of the human temporal bone (middle ear and

mastoid); 2) to demonstrate how to obtain and generate such 3D

images with simple equipment, discussing the technical difficulties found

to acquire and edit such images.

INTRODUCTION

METHODS AND MATERIALS

CONCLUSIONS

RESULTS

Figures 1,2,3,4,5,: Stereoscopic 3D images of the middle ear and mastoid.

ABSTRACT

CONTACT

The stereoscopic reproduction methods have already been described in

the mid 19th century9. Since the second half of last century, several

stereoscopic reproduction techniques have been developed for

projection and printing. However, the advance of digital cameras and

computer programs for the last years has strongly facilitated and

optimized the performance and spread of 3D stereoscopic images.

In our area, the use of 3D stereoscopic images, which enable a real

deepness perception, may be extremely useful for a better

demonstration of anatomic structures in their several levels of macro-

and endoscopic observation, thus providing an important teaching and

documentation tool.

DISCUSSION

PLEASE USE ANAGLYPH GLASSES (RED AND CYAN) MORE INFORMATIONS: WWW.SINUSCENTRO.COM.BR

Tympanic membrane Chorda tympani

Middle ear cavity

Ponticulus

1. Ribas GC, Bento RF, Rodrigues Jr AJ. Reproduções impressas de imagens tridimensionais estereoscópicas para ensino, demonstrações e

documentações. Arq Int Otorrinolaringol. 2000, 4(2):48-54.

2. Bento, RF; Ribas, GC; Sanchez, TG; et al. Demosntração Tridimensional da Anatomia Cirúrgica do Osso Temporal. Arq Int Otorrinolaringol.

2000, 4(2):43-47.

3. Trelease RB. Toward Virtual Anatomy: A Stereoscopic 3D Interactive Multimedia Computer Program for Cranial Osteology. Clin Anat. 1996,

9:269-272.

4.Trelease RB. The Virtual Anatomy Practical: A Stereoscopic 3D Interative Multimedia Computer Examination Program. Clin Anat. 1998, 11:89-

94.

5. Bassett DL. A Stereoscopic Atlas of Human Anatomy. Portland: Sawyer's Inc., 1961;

6. Chase RA. A Stereoscopic Atlas of Human Anatomy, The Bassett and Gruber Legacy, 3D Book Productions, Borger, 1994.

7. Kraus GE, Bailey GJ. Microsurgical Anatomy of the Brain: A Stereo Atlas. Baltimore: Williams and Wilkins, 1994; 8. Poletti CE, Ojemann RG.

Stereo Atlas of Operative Microneurosurgery. St. Louis: CU Mosby Co., 1985.

REFERENCES

A schematic drawing of the retrotympanum in

the right ear. It is useful to start superiorly at

the oval window and move inferiorly: from the

posterior sinus, then the sinus tympani, the

sinus subtympanicum, and the hypotympanum.

FN = Facial Nerve; Po = Ponticulus promontorii;

STY = Styloid Prominence; TE = Temen of the

Round Window; Po = Ponticulus;

SU = Subiclum; JB = Jugular bulb

Sub-pyramidal space

Facial nerve