A 34 year-old woman presented with a left mandibular mass that had been present for approximately 5 months. Physical examination demonstrated a 5 cm left submucosal oral cavity lesion with clinically evident mandibular expansion and erosion. CT imaging demonstrated a 5.5 × 3.1 cm mandibular lesion. Several small lymph nodes were also shown on the both sides of the neck, the larger diameter of which was approximately 0.7 cm (Fig. a). A biopsy of the left mandibular mass showed fibrous lesions of bone which inclined to cementite fibroma.\nWe used CAD/CAM technology to develop a surgical treatment plan. Based on the tumor size and areas of invasive disease, segmental mandibulectomy was simulated. We modeled the simulated cut with the iliac bone in the defect area in the width, thickness, and angle. The place for osteotomy of the iliac bone was determined, and the virtual reconstruction was performed. A three dimensional solid model, osteotomy template of the lesion, and the iliac bone were developed through a 3D printer. Pre-bent titanium plates were prepared by the reconstructive model of rapid prototyping.\nFollowing the simulated surgery, the left mandibular segmental resection with free iliac myocutaneous flap reconstruction with titanium plate fixation were performed under the general anesthesia. (Fig. b, c). Prefabricated titanium plates were used to fix the iliac bone to the mandibular resection defect (Fig. d). The defect in the oral cavity was repaired with the muscle flap. During the follow-up, the second stage of dental implants were placed 1.5 years after the first stage of operation (Fig. e). Currently the patient had a nice facial appearance with an excellent occlusion, and a functional oral cavity (Fig. f).
A 17-year-old female patient was admitted to the hospital on September 9, 2019 with abdominal pain that had lasted for half a year and had been worsening for half a month.\nOn September 8, 2019, the patient visited Xiamen Third Hospital for an abdominal US. A homogeneous mass with fluid echo was detected in the left middle abdomen that was suspected as being a retroperitoneal tumor. The patient came to our hospital for further diagnosis and treatment.\nThe patient was in good health with no history of infectious disease, allergy, or surgery.\nThe patient has no family or genetic history of disease.\nA standard physical examination was performed. The abdomen was flat and soft; there was tenderness on the left side but no rebound tenderness and no Murphy’s sign. The mass in the left middle abdomen was about 8 cm × 10 cm in size, with an intact capsule but without a distinct boundary; the mass showed poor mobility with tenderness elicited in the palpation test. The liver and spleen were impalpable under the ribs, and there were no obvious gallbladder abnormalities. Further physical examination revealed drum sounds on percussion, negative shifting dullness, and normal bowel sounds on auscultation.\nNo abnormalities were found in the routine blood, urine and stool analysis, or liver and kidney function.\nA clinical examination after admission on September 9, 2019 revealed sinus arrhythmia by electrocardiography, and a pulmonary nodule in the right lower lobe by helical CT that may have been an old pulmonary lesion. Abdominopelvic enhanced helical CT showed a retroperitoneal space-occupying lesion in the upper left quadrant of the abdomen that was presumed to be retroperitoneal liposarcoma or teratoma (Figure ).\nWe used the proprietary XMQB-Liver software (Xiamen Qiangben Technology Co, Xiamen, China) for 3D reconstruction of CT images. The software allowed rotation, blurring, and elimination of elements in the 3D model (Figure ), provided omnidirectional views (Figure and ), and allowed tumor virtualization (Figure ), removal of normal organs, and observation of the relationship between the tumor, blood vessels, and surrounding organs (Figure ). The tumor was located in the upper left retroperitoneum and was about 11.3 cm × 9.1 cm in size with well-defined borders; it compressed the left renal artery and vein, resulting in vascular displacement and deformation. The inferior vena cava and abdominal aorta were unaffected. The left kidney and adrenal gland were shifted forward and downward under pressure; there was no visible invasion of the liver, spleen, pancreas, or stomach. The intestines could not be reconstructed.