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 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.