How we do it: anterior and posterior nosebleed trainer, the 3D printing
Chiesa Estomba, C.M.,* Gonz
& Iglesias Otero, M.
*Otorhinolaryngology – Head and Neck Surgery Department, University Hospital of Vigo, Vigo, Pontevedra,
DQbito Biomedical Engineering, Ourense, Spain
Accepted for publication 14 July 2016
Clin. Otolaryngol. 2018, 43, 765–766
stated that simply watching an expert do a
procedure will not increase a student’s ability to perform
that procedure. In this way, training should consist of more
than a slow demonstration of a procedure at the bedside by
Epistaxis is a common and potentially life-threatening
condition. In the emergency room, doctors admit around
81% of nasally packed patients under ENT, but only 17%
have received training about managing epistaxis.
the subsequent consequences that nasal pack replacement
causes, including further pain and discomfort and the lack of
training, have implications for patient safety.
Junior emergency doctor and junior ENT doctors are
exposed to nosebleeding at the beginning of their training,
dealing with different kinds of cases from simple to more
complex. Therefore, simulation can be a useful method of
reinforcing learning about nasal packing.
Three-dimensional printing is a layered manufacturing
method that can be used to fabricate complex structures.
Using 3D printing, a physical object can be fabricated from a
3D computer-aided design model layer by layer, more
conveniently and more rapidly than other manufacturing
means. Additionally, it is easy to customise a product
according to personal requirement.
Materials and methods
To construct our nosebleed simulator, we retrospectively
reviewed different CT scan from our rhinology department
database. DICOM data were imported into Osirix Viewer v
5.5 32-Bit (Pixmeo SarI). The best resolution and non-
deformed nasal pathway was selected. Then, the DICOM data
were imported into the different three-dimensional printing
software: 3D Slicer
(3D Slicer Software), Meshmixer
(Autodesk, Inc.) and Solidworks (Dassault Syst
SolidWorks Corporation) to develop our training model.
The head of our model was printed using polylactic acid, and
the nose was printed using polyurethane (Fig. 1).
At the level of the anterior cranial fossa, a hole was
designed through the anterior and posterior aspect of the
cribriform plate, on both sides, to simulate the anterior and
posterior ethmoidal arteries. Moreover, another hole was
designed and opened behind the ethmoidal crest to simulate
a posterior epistaxis from the sphenopalatine artery (Fig. 2).
The last hole was designed through the vomer bone, and this
hole ends inside the quadrangular cartilage to simulate
anterior epistaxis (Little’s area). Then, several tubes were
positioned into every hole and they were all connected to a
hydraulic system, to pump saline and food colouring to
emulate blood. The system works through compression and
decompression of a hydraulic pump, allowing simulation of
During the training, the simulator was placed over a
bearing (Fig. 2), and the resident has the opportunity to
practice anterior rhinoscopy and navigate inside the simu-
lator with a Hopkins telescope (0-30°) to determine the
source of bleeding. Moreover, they can pack both nostrils to
try to stop the bleeding. Afterwards, at the end of the practice,
residents ﬁll out a satisfaction questionnaire and answer a
test, in relation to the knowledge gained during practice.
In this paper, we describe a 3D printing nosebleed training
model, which allows residents from different specialities to
practice diagnosis and treatment of this pathology in a risk-
free environment while guaranteeing the reproducibility of
the technique under the same conditions.
This is a cheap model, aside from the cost of the 3D
impression and the nasal packing materials; the simulator
only requires saline with food colouring to simulate blood.
Although the simulator cannot replace real-life situations,
this is a great tool to help residents practice nasal exploration
Correspondence: C.M. Chiesa Estomba, Department of
Otorhinolaryngology – Head and Neck Surgery, University Hospital of
Vigo, rua Pizarro, #11, 4to D. 36204, Vigo, Espa
na. Tel.: 0034 635 793 435;
© 2016 John Wiley & Sons Ltd
Clinical Otolaryngology 43, 765–766