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 35 year-old female presented with a right neck mass that she noticed 5 months previously. The tumor was approximately 3 × 3 cm and was initially discovered due to a work-up for a stroke. A contrast-enhanced neck CT showed a 2.5 × 2.5 cm tumor at the right carotid artery bifurcation (Fig. a). The tumor surrounded the initial segment of internal and external carotid artery, with circumferential collateral vessels consistent with a carotid body tumor. CTA confirmed right common, internal and external carotids supplying the tumor (Fig. b). Preoperative VR technique was used to make individual models and to perform preoperative simulation of the anticipated resection (Fig. c). The unique perspective of using VR technology to view the blood vessels, called “intravascular peep”, clearly demonstrates vascular compression or vascular invasion (Fig. d, e). After optimizing the preoperative planning, the patient underwent right carotid body tumor resection. VR allowed the surgeon to practice the gradual separation of the tumor at the carotid bifurcation.