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 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).