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 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.