Virtual Endoscopy and 3-D Reconstruction in Patients with Airway Pathology

  • Imran Ahmad
  • Britta Millhoff
  • Sarah Muldoon
  • Kayathrie Jeyarajah


The assessment and airway planning of patients with airway pathology can be challenging as the current bedside airway assessment tools are often inadequate due to their low sensitivity and specificity. Almost all of these patients would have had a multi-plane computerised tomography (CT) of the head and neck as part of the diagnostic process. In addition to this many would also have had a flexible nasal endoscopy with an associated hand-drawing by the surgeon or a still image in the notes. With three-dimensional (3-D) reconstruction and virtual endoscopy (VE) performed either by the radiologist, anaesthetist or surgeon on an Apple Mac workstation with easily available software such as OsiriX® and HOROS, an inside simulated view of the airway or the pathology can be obtained. This can then be utilised to formulate an airway management plan. Three-dimensional reconstruction of the patient’s head and neck anatomy gives a better understanding of how it is affected by pathology in and around the upper airway. This well-established tool has already shown its value in diagnosing intra-luminal lesions of the airway and bronchial tree and there is now growing evidence demonstrating the benefits of this technology in visualising and mapping out an airway management plan in patients with head and neck pathology.


Airway planning Airway pathology (3-D) reconstruction Virtual endoscopy (VE) Head and neck pathology Upper airway imaging 

Supplementary material

Movie 5.1

Real-time assessment of the upper airway obtained by flexible naso-endoscopy (the main editor is the one appearing in the video). (MP4 120839 kb)

Movie 5.2

Volume-rendering technique TTP showing the level and extent of the trans-glottic indentation and displacement of the airway by the mass lesion (MP4 3192 kb)

Movie 5.3

Glottic tumour involving the arytenoid cartilages seen by VE movie (MP4 3325 kb)

Movie 5.4

Large supraglottic obstructing airway pathology arising from the right vallecula and pushing the epiglottis over to the left proved by VE movie (MP4 4262 kb)

Movie 5.5

VE of a patient with a base of tongue tumour and the abnormally shaped epiglottis (MP4 3469 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Imran Ahmad
    • 1
  • Britta Millhoff
    • 1
  • Sarah Muldoon
    • 1
  • Kayathrie Jeyarajah
    • 1
  1. 1.Guy’s & St Thomas’ NHS Foundation TrustLondonUK

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