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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

Jang, Wan-Hee DDS*; Lee, Jake Minki BS; Jang, Sam BS; Kim, Hee-Dong BS§; Ahn, Kang-Min DDS, PhD||; Lee, Jee-Ho DDS, PhD

doi: 10.1097/SCS.0000000000005577
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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.

*Resident, Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Republic of Korea

Student, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, United States of America

Director, Coreline Soft

§Manager, Coreline Soft

||Professor, Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan

Associate Professor, Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.

Address correspondence and reprint requests to Jee-Ho Lee, DDS, PhD Associate Professor, Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro, Songpa-gu, Seoul 138-736, Republic of Korea; E-mail: jeehoman@naver.com

Received 6 February, 2019

Accepted 8 March, 2019

The authors have no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.