(721) Patient-Specific 3D-Printed Preoperative Planning for Septal Button Closure of Complex Tracheoesophageal Fistula

Introduction: Managing tracheoesophageal fistula (TEF) can be challenging in patients with distorted post-surgical anatomy, where conventional imaging may not provide enough guidance. We report a case demonstrating how patient-specific 3D-printed models can aid preoperative planning and improve procedural outcomes for complex TEF closure.

Methods: This single-patient case report was conducted at Southern Illinois University School of Medicine in 2025. The patient is a 60-year-old male with advanced papillary thyroid carcinoma who had previously undergone thyroidectomy, bilateral central and left selective neck dissection, and tracheostomy. He developed an 8-mm left posterolateral tracheoesophageal fistula (TEF) at the thoracic inlet, complicated by recurrent aspiration pneumonia. Preoperative planning included patient-specific 3D-printed models of the trachea and esophagus generated from segmented CT imaging. The models facilitated assessment of fistula orientation, implant sizing with sample septal buttons, and refinement of insertion technique through the tracheostomy. Outcome measures included successful septal button placement, implant patency on follow-up, swallow function, and postoperative complications. The primary variable of interest was the use of patient-specific 3D-printed modeling to guide procedural planning.

Results: The septal button was successfully placed under general anesthesia without complications. Swallow studies at two, eight, and twenty weeks demonstrated implant patency without leak. Six-month tracheoscopy showed a well-fitting implant. The patient transitioned from gastrostomy tube dependence to a normal diet and experienced no further aspiration-related hospitalizations.

Conclusions: Patient-specific 3D-printed models improved preoperative planning and execution for complex TEF closure, resulting in successful septal button placement, implant patency, and restoration of swallow function. As a single-patient case, broader generalization is limited, but this approach may reduce intraoperative setbacks, complications, and postoperative costs.