Use of 3D reconstruction of CT images in surgical planning of laryngeal fracture repair

Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the advantages of using 3D reconstruction of CT images to analyze laryngeal fractures for surgical planning. Study Design: Case report and development of image processing algorithm. Methods: A 30 year old man sustained blunt trauma to the neck. Axial CT images showed a significantly displaced posterolateral cricoid fracture. The images were imported into Adobe Photoshop to separate the densities corresponding to the cricoid and thyroid cartilages. The separated images were processed with custom routines written in MATLAB. 3D reconstructions of the laryngeal framework were generated for surgical planning. Results: Image processing algorithms were developed using MATLAB to allow versatile 3D reconstruction of the laryngeal framework. Independent renderings of the cricoid and the thyroid with different opacities allowed viewing of the cricoid fracture through the thyroid cartilage, which facilitated surgical planning. The 3D reconstructions suggested an open, lateral approach to the fracture line and also pointed to the necessity of a second approach to apply force in the appropriate direction to reduce the fracture. The surgery was carried out using a combined lateral approach and temporary cricothyrotomy. A thyrotomy or laryngeal stent was not necessary. Postoperative CT images were reconstructed in a similar manner and demonstrated successful reduction of the cricoid fracture. Conclusions: The use of 3D reconstructions from routinely obtained axial CT images can facilitate the appreciation of the 3D anatomy of laryngeal fractures and potentially improve surgical planning.