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

• Published in: The Journal of craniofacial surgery Vol. 30; no. 6; p. 1829
• Main Authors: Jang, Wan-Hee, Lee, Jake Minki, Jang, Sam, Kim, Hee-Dong, Ahn, Kang-Min, Lee, Jee-Ho
• Format: Journal Article
• Language: English
• Published: United States 01.09.2019
• Subjects: Computer Simulation; Free Tissue Flaps - transplantation; Humans; Iliac Artery - diagnostic imaging; Iliac Artery - surgery; Male; Maxilla - blood supply; Maxilla - diagnostic imaging; Maxilla - surgery; Middle Aged; Printing, Three-Dimensional; Reconstructive Surgical Procedures - methods
• ISSN: 1536-3732
• DOI: 10.1097/SCS.0000000000005577

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.