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.
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.