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Success of 3D Printing Technology Assisted Dual Oral Cancer Surgery
Recently, the Second Department of Head and Neck Surgery of Hunan Cancer Hospital has successfully operated a radical and repair surgery for a patient suffering left cheek cancer and right tongue cancer by the bilateral anterolateral thigh flap transplantation. This case has employed 3D printing technology and pre-operative CTA vascular reconstruction.
Dual Oral Cancers Found in a Man
Mr. Yang, 49 years old, has been found a mass on the left oral cavity half a year ago. And the mass has gradually invaded to the local skin. Checked in local hospital, it is found there is a neoplasia in the right side of his tongue which be proven to be “squamous cell carcinoma” by the biopsy. When told about the cancer and the difficulty to treat the cancer, the patient and his family were in great pains. They have resorted to many places and finally came to the Second Department of Head and Neck Surgery of Hunan Cancer Hospital for help.
After carefully reviewing the case and relevant examinations, the department director, Yu Jianjun, has provided him with a detailed surgery protocol. According to the protocol, it needs to repair the defects after perforating the left cheek and resecting the right side of the tongue by three pieces of flap which are recommended to be bilateral anterior lateral thigh flap (ALT).
“Therefore, it is very important to precisely evaluate the primary lesion resection scope, flap positioning and perforating as well as areas supplying the flap.” Director Yu has proposed the joint application of 3D printing technology and CTA vascular reconstruction technology to provide technical support for accurate surgery.
Success of the Radical and Repair Surgery within 13 Hours
Then, members of the surgery team headed by the associate professor, Tian Hao, has immediately engaged in surgery preparation work: after the Radio-diagnosis Department provided the useful imaging data, they communicated and discussed again and again with technicians from the 3D printing company to work out the tumor position and the expanded resection scope in line with the surgery principles by software； after CTA vascular reconstruction of the bilateral lower limbs, they marked the perforation and selected the flap supply side and precisely designed the position, size, and orientation of the flap by combining the size, shape, and thickness of the tissue defect after printing；and consummated the relevant preparation after communicating with the Anesthesiology Department.
Finally, On May 24, 2016, under the guidance of Director Yu, the surgery team headed by Dr. Tian Hao has successfully performed the surgery, lasting over 13 hours. Then, the patient has been discharged after being taken care of well. His rehabilitation is good.
3D Printing Escorts Precision Surgery
Yu Jianjun, the Department Director, has introduced that this case involving a patient with dual oral cancers is intricate to deal with, and rare clinically. Particularly, the lesions are located at both sides of the mouth, with large-scale defects. It is very hard to repair them with three pieces of flap from a set of vascular pedicle. Bilateral ALT is needed. Given the fact that the leg muscle of the patient is strong, if the skin is cut too much, it will make the cut unable to be sutured and grows wider. Therefore, it has proposed to perform bilateral neck dissection, left cheek perforation and resection, right side tongue resection and bilateral free anterolateral thigh flap repair simultaneously.
In this case, the 3D printing technology not only replicated the tumor, but also printed the expanded resection part through simulation technique, which made the radical surgery more reasonable and precise. Moreover, the experts used the CTA and three-dimensional vascular reconstruction technology to clarify the condition of lower limbs perforated vessel. And they have designed a precise and individualized flap pre-operatively considering the defect size, orientation, thickness on the 3D printed model of Oral and Maxillo-facial Region, so as to ensure the smooth performance of the surgery, minimize the trauma of the flap area, and achieve the satisfactory treatment effect.