In the recently published ‘Combined application of virtual surgery and 3D printing technology in postoperative reconstruction of head and neck cancers,’ scientists from both the US and China collaborated on a study to integrate virtual and 3D printing applications into postoperative treatment of cancer.
The authors shared five cases taken on by the head and neck surgery department where reconstruction was performed. Reminding us that both the head and neck are ‘exceptionally complex,’ this is an area where organs, vessels, and nerves meet. When tumors grow in such an area, total resection is the only choice, and sometimes the surgery must be radical to ensure success.
While every surgery is important, removal of a tumor from the head or neck must be well-planned:
“In order to achieve complete resection and efficient and effective functional reconstruction, it is particularly important to develop a reasonable preoperative surgical plan and execute that plan in the operating room,” stated the researchers.
The use of typical 2D methods today like ultrasound, CT, or MRI may show the connection between a tumor and surrounding tissue, but further evaluation can be limited. As a result, surgeons are challenged to plan for surgeries comprehensively. Virtual surgery and augmented reality techniques, however, along with 3D printing and robotics, make it much easier for surgeons to create a personalized approach today for treatment, along with each step of a medical procedure, and post-operative measures.
Virtual reality simulates a digital 3D world, and for surgeries—especially that of a more complex area like the head and neck—it can actually be used in a capacity that ‘virtually’ replaces a human assistant, helps assess the course of action for the operating room, and acts as a surgical guide too.
“Applying VR technology to the head and neck can make complex structural relationships vivid and stereoscopic, making an abstract concept intuitive and clear, and bring great flexibility to the operative field. We recognize the importance of the application of CAD / CAM and VR technology in head and neck surgery,” stated the researchers.
The researchers outlined the cases:
Case One – 53-year-old female with mass in her left neck, history of recurrent breast cancer, and multiple surgeries related to that. The biopsy showed that the mass in her left neck was malignant fibrous histiocytoma. Surgeons used VR to simulate the surgery, with the use of a 3D reconstructed model including:
- Color coding of important structures
- Blood vessels
“Following use of the VR with multiple sessions, the patient underwent extended excision of left cervical and thoracic junction tumor with partial left clavicle resection, left subclavian vein repair, and pectoralis major myocutaneous flap repair under general anesthesia,” stated the researchers.
Case Two – 35-year-old female presented with 3 × 3 cm right neck mass, discovered during examination for a stroke. Surgeons used VR to create 3D printed models and simulate resection.
“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,” stated the researchers.
Case Three – 50-year-old female with adenoid cystic carcinoma, presented with a 5.0 × 4.5 cm mass in her left cheek. A 3D model was created, and simulated reconstruction followed.
“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,” stated the researchers.
Case Four – a 51 year-old male was discovered to have a 2.5 × 3.5 cm left gingival squamous cell carcinoma. The left mandible was included, along with multiple ipsilateral lymph nodes. A 3D model was created, along with an osteotomy plate.
“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,” stated the researchers.
Case Five – a 34-year-old woman presented with a 5 cm left submucosal oral cavity lesion, also affecting several lymph nodes.
“A biopsy of the left mandibular mass showed fibrous lesions of bone which inclined to cementite fibroma,” stated the researchers.
“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.”
“We conclude that computer-assisted surgery for personalized reconstruction of complex defects of the head and neck has role in clarifying tumor anatomy relationships, reconstructing complex osseous and soft tissue defects and defining vascular lesions such as aneurysms and vascular tumors,” stated the researchers, ultimately.
“This information leads to precise surgical treatment of head and neck cancer patients. However, its application in head and neck surgery is still limited. More systematic clinical results are needed to confirm the overall and reliable clinical value. Nonetheless, we believe that using computer-aided digital surgical technology to evaluate, simulate, formulate, and implement operative plans is an important trend in the future of head and neck surgery.”
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