Cholesteatoma in three dimensions: A teaching tool and an aid to improved pre-operative consent

Background: Otological surgeons face two recurring challenges. Firstly, we must foster an appreciation of the complex, three-dimensional anatomy of the temporal bone in order to enable our trainees to operate safely and independently. Secondly, we must explain to our patients the necessity for surgery which carries the potential for serious complication. Methods: Amira® software was applied to pre-operative computed tomography images of temporal bones with cholesteatoma, to create three-dimensional computer images. Normal structures and cholesteatoma were displayed in a user-friendly, interactive format, allowing both trainee and patient to visualise disease and important structures within the temporal bone. Results: Three cases, and their three-dimensional computer models are presented. Zoom, rotation and transparency functions complemented the three-dimensional effect. Conclusion: These three-dimensional models provided a useful adjunct to cadaveric temporal bone dissection and surgical experience for our residents' teaching programme. Also, patients with cholesteatoma reported a better understanding of their pre-operative condition when the models were used during the consenting process.