A 50 year-old female with history of adenoid cystic carcinoma status post partial maxillectomy 3 years ago, presented with recurrence in the left maxilla. A 5.0 × 4.5 cm mass was palpable in left cheek and she underwent radiation therapy with minimal to no response. When the patient presented our service, she underwent preoperative examination and imaging. Maxillofacial contrast-enhanced CT (Fig. a) and CT three-dimensional reconstruction of the lesion and of the lower extremity vessels was performed by CAD technique (the 3-dimensional reconstruction technology and virtual surgery) after CT angiography (Fig. b, c). Before surgery, a rapid prototyped template was manufactured to help determine the planned lengths and angles of the fibula osteotomies and to guide the insertion of dental implants, which were placed in the free fibula graft prior to resection. In addition, a premanufactured infraorbital implant was planned for insertion to compensate for the patients infraorbital and zygomatic bony defect. The simulated reconstruction was modeled on the computer (Fig. d-f) with rapid prototyping by 3D printer (Fig. g). The patient then underwent excision of the maxillary tumor, nasal septal resection, bilateral neck dissection, fibula myocutaneous flap repair, and abdominal free skin grafting. We use a 3D printed osteotomy plate after CAD design to precisely perform the appropriate osteotomies for resection of the tumor. A pre-bent titanium plate and screw were used to fix the jaw. The precise nature of respectable osteotomy and preplanned pre-bent plate allowed for a more personalized reconstruction.
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.