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 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.