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 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.