Mirror Image Based Three-Dimensional Virtual Surgical Planning and Three-Dimensional Printing Guide System for the Reconstruction of Wide Maxilla Defect Using the Deep Circumflex Iliac Artery Free Flap

Abstract

A patient was diagnosed with squamous cell carcinoma of the maxillary sinus and consequently underwent a unilateral total maxillectomy and reconstruction using an anterolateral thigh (ALT) free flap. Soft tissue transplantation without a bone graft at the large maxillary defect site caused a midfacial collapse, which worsened, especially after radiotherapy. The 3-dimensional positioning of the composite flap for wide maxillary reconstruction is aesthetically important. To achieve ideal symmetry and aesthetics, a mirror image was created using the normal contralateral side. Through computer simulation, the function and symmetry of the virtually reconstructed maxilla was evaluated, and the surgical guide was made using a 3D printing system. Based on the prepared surgical guide, a deep circumflex iliac artery (DCIA) free flap was harvested, and its implementation in the reconstruction ultimately led to satisfactory results. Utilization of mirror image based virtual surgical planning and a 3D printing guide is a significantly effective method for maxilla reconstruction with DCIA flaps.

Easy, Fast, and Accurate Method of 3-Dimensional Mirror Plane Creation for Actual Clinical Users

“…The benefits of using mirror images are expected to be exceedingly productive when they are combined with bio-printing and even tissue engineering. In addition, this kind of application of current technologies would lead surgeons to the next level of oral and maxillofacial surgery, such as the fabrication of bio-reactive scaffolds that can be an alternative for the traditional free flap surgeries [6,14]. Donor site morbidity would thereby no longer be an issue, eventually pursuing a decreased duration of surgery and recovery time.…”

“…In addition, useful engineering algorithms, such as iterative closest point (ICP) could extend the utilization of currently growing resources in the medical field by improving the accuracy and rate of convergence. From this technological advance, virtually mirrored 3D images of normal anatomic structures can provide an ideal image of desired structure for reconstruction of the defects or correction of the asymmetries [6,7]. By using these mirror images, surgeons can obtain a lot of useful information for treatment plans, such as volume, form, location, and dimension measures of the affected sides [8].…”

Midface Reconstruction: Planning and Outcome

“…A premade gutter splint of the upper alveolus is often used as a template during in situ alveolus recreation 22 (►Fig. 4).…”

“…This facilitates more cohesive teamwork, reduces ischemia time, and shortens the overall operating time. 22,30,32 3D models are both educative to the patient as well as the surgical team. Preprinting implants are also being explored with the future being directed toward printing patient-specific implants which can be biologically integrated.…”

“…Further surgical procedures 21,22 may be necessary to correct the shortcomings of the primary procedure, the changes following radiation and to achieve functional or aesthetic improvement. Plate exposure, contour defects, orbital deficits, and nasal deficits are some common problems.…”