A 51 year-old male presented with a 2 month history of a 2.5 × 3.5 cm left gingival squamous cell carcinoma. On physical exam, the left mandible was involved as were multiple ipsilateral lymph nodes. The largest of which was 3 × 3 cm. The contrast-enhanced MRI scan in the maxillofacial region is shown in Fig. a. We used CAD/CAM technology to assist with surgical planning (Fig. b, c), then we used plastic and a resin composite material for rapid prototyping through the 3D printer (Fig. d-g). We developed an equiratio 3D anatomical model and osteotomy plate. The patient underwent segmental mandibulectomy with free fibula reconstruction (Fig. h). The fibula osteotomies on the pedicle vascularized free fibular flap were cut according to the preoperative simulation (Fig. g). A custom pre-bent plate was designed according to the computer simulation and the 3D model. We fixed the custom titanium plate at a predetermined position according to the simulation data and 3D model, and the oral defect was simultaneously repaired by the soft tissue component of the flap (Fig. i, k).\nPost-operatively the reconstruction did well. The patient was followed up with good facial morphology and postoperative CT imaging showed good contour of the fibula. The fixation position of titanium plate screws were accurate (Fig. l), and the occlusion was normal (Fig. m).
A 53 year-old female presented with a left neck mass. Her past medical history is significant for recurrent breast cancer that required multiple surgeries including radical mastectomy and two courses of chemoradiotherapy. Three years prior to presentation, a mass was found in her left neck. A needle biopsy demonstrated malignant fibrous histiocytoma. Imaging with CT and MRI were obtained and shown in Fig. a, b. Following preoperative physical examination and imaging, VR was used to simulate the operation. The CT and MRI data were collected and converted into DICOM format. The DICOM image was tested to ensure that the image meets quality standards. The DICOM images were used to perform a three dimensional reconstruction of the area of anticipated resection. Multimodal image fusion of CT and MRI was performed using precision detection by medical imaging experts. The multimodal 3D reconstruction model was transformed into VR model, with color coding of important structures, blood vessels, nerves, bone and tumor for convenient recognition. This model is imported into the UE4 engine to take advantage of function customization. After settling cluster rendering equipment and 3D scanner, surgeons wear head mounted display and data gloves for surgical simulation to pick up and rotate the model, or to change functions such as zoom, model resolution, and profile in the virtual operation room (Fig. c). Following use of the VR with multiple sessions, the patient underwent extended excision of left cervical and thoracic junction tumor with partial left clavicle resection, left subclavian vein repair, and pectoralis major myocutaneous flap repair under general anesthesia.