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 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.