scholarly journals Surgical Navigation, Augmented Reality, and 3D Printing for Hard Palate Adenoid Cystic Carcinoma En-Bloc Resection: Case Report and Literature Review

2022 ◽  
Vol 11 ◽  
Author(s):  
Mónica García-Sevilla ◽  
Rafael Moreta-Martinez ◽  
David García-Mato ◽  
Gema Arenas de Frutos ◽  
Santiago Ochandiano ◽  
...  

Adenoid Cystic Carcinoma is a rare and aggressive tumor representing less than 1% of head and neck cancers. This malignancy often arises from the minor salivary glands, being the palate its most common location. Surgical en-bloc resection with clear margins is the primary treatment. However, this location presents a limited line of sight and a high risk of injuries, making the surgical procedure challenging. In this context, technologies such as intraoperative navigation can become an effective tool, reducing morbidity and improving the safety and accuracy of the procedure. Although their use is extended in fields such as neurosurgery, their application in maxillofacial surgery has not been widely evidenced. One reason is the need to rigidly fixate a navigation reference to the patient, which often entails an invasive setup. In this work, we studied three alternative and less invasive setups using optical tracking, 3D printing and augmented reality. We evaluated their precision in a patient-specific phantom, obtaining errors below 1 mm. The optimum setup was finally applied in a clinical case, where the navigation software was used to guide the tumor resection. Points were collected along the surgical margins after resection and compared with the real ones identified in the postoperative CT. Distances of less than 2 mm were obtained in 90% of the samples. Moreover, the navigation provided confidence to the surgeons, who could then undertake a less invasive and more conservative approach. The postoperative CT scans showed adequate resection margins and confirmed that the patient is free of disease after two years of follow-up.

2021 ◽  
pp. 1-6
Author(s):  
Camilo A. Molina ◽  
Christopher F. Dibble ◽  
Sheng-fu Larry Lo ◽  
Timothy Witham ◽  
Daniel M. Sciubba

En bloc spinal tumor resections are technically demanding procedures with high morbidity because of the conventionally large exposure area and aggressive resection goals. Stereotactic surgical navigation presents an opportunity to perform the smallest possible resection plan while still achieving an en bloc resection. Augmented reality (AR)–mediated spine surgery (ARMSS) via a mounted display with an integrated tracking camera is a novel FDA-approved technology for intraoperative “heads up” neuronavigation, with the proposed advantages of increased precision, workflow efficiency, and cost-effectiveness. As surgical experience and capability with this technology grow, the potential for more technically demanding surgical applications arises. Here, the authors describe the use of ARMSS for guidance in a unique osteotomy execution to achieve an en bloc wide marginal resection of an L1 chordoma through a posterior-only approach while avoiding a tumor capsule breach. A technique is described to simultaneously visualize the navigational guidance provided by the contralateral surgeon’s tracked pointer and the progress of the BoneScalpel aligned in parallel with the tracked instrument, providing maximum precision and safety. The procedure was completed by reconstruction performed with a quad-rod and cabled fibular strut allograft construct, and the patient did well postoperatively. Finally, the authors review the technical aspects of the approach, as well as the applications and limitations of this new technology.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Georgios Gkagkalis ◽  
Kevin Moerenhout ◽  
Hannes A. Rüdiger ◽  
Daniel A. Müller ◽  
Igor Letovanec ◽  
...  

Primary tumors of the pelvis are considered difficult to treat due to the complex anatomy and the proximity of important neurovascular structures. The surgical armamentarium for the treatment of these tumors has evolved with the help of cutting-edge technology from debilitating hemipelvectomies to solutions such as precise resections guided by patient-specific instruments or computer navigation and reconstruction by modular prostheses, 3D-printed custom-made implants, or orthotopic autograft reimplantation after extracorporeal irradiation. Different combinations of these techniques have been described in the literature with various rates of success. We present two cases of pelvic chondrosarcomas successfully treated by a combination of periacetabular resection with patient-specific osteotomy guides and orthotopic reimplantation of the extracorporeally irradiated autograft resulting in retention of the native hip.


2018 ◽  
Vol 42 (4) ◽  
pp. 243-247
Author(s):  
Arnulfo Torres G ◽  
Helen Silva L

Introducción: Los tumores de Senos paranasales y cavidad nasal representan el 0.2% de todos los cánceres; son más frecuentes en hombres y predominantemente unilateral; los tipos histológicos más comunes son el Carcinoma escamocelular y los carcinomas de glándulas salivales menores, dentro del cual, se encuentra el carcinoma adenoideo quístico. Las bases del tratamiento para las lesiones resecables combinan radioterapia y cirugía radical cuyo abordaje puede ser endoscópico, abierto (ej. degloving mediofacial) o la combinación de ambos. Objetivo: Describir un abordaje por degloving para la realización de una maxilectomía parcial y presentarlos resultados de nuestra experiencia clínica en un paciente con una masa en fosa nasal con diagnóstico de carcinoma adenoideo quístico. Diseño: Reporte de caso Materiales y métodos: Se presenta el caso de un varón de 57 años, quien consultó por epistaxis intermitente en fosa nasal izquierda de un año de evolución, con nasosinuscopia que mostró una lesión abombada en tercio medio de cornete inferior y piso de fosa nasal y una lesión violácea en paladar óseo a nivel paramediano izquierdo; identificándose histopatológicamente como carcinoma adenoideo quístico patrón tubular y adenoideo, estadificado como T3N0M0. Se consideró la realizaciónde maxilectomía parcial por abordaje de degloving mediofacial. Resultados: La estancia hospitalaria postquirúrgica fue de 3 días y no presentó complicaciones ni recurrencia hasta la fecha. Conclusiones: El abordaje con degloving mediofacial y maxilectomía parcial, permite resecar el tumor nasosinusal en bloque con márgenes amplios; y la reconstrucción con prótesis, una rápida rehabilitación de la función masticatoria y de resonancia fonatoria.Introduction: Tumors of nasal cavity and paranasal sinuses represent 0.2% of all cancers; they are more common in men and presentation is predominantly unilateral; the most common histological types are the squamous cell carcinoma and carcinoma of minor salivary glands, within which, adenoid cystic carcinoma is located. The basis of treatment for resectable lesions combine radiotherapy and radical surgery whose approach may be endoscopic or open (e.g. midface degloving) or a combination of both. Objective: To describe an approach by degloving to perform a partial maxillectomy and present the results of our clinical experience in a patientwith a mass in left nasal fossa with histopathological diagnosis of Adenoid Cystic Carcinoma. Design: Case report. Materials and methods: We present a case of a 57 year old man, with a history of intermittent epistaxis from the left nasal fossa during a year, whose nasoscopy showed a bulging lesion on the middle third of the inferior turbinate and nasal fossa floor and a purplish lesion on bony palate at paramedian left level; it was identified histologically as adenoid cystic carcinoma with tubular and adenoid pattern, staged as T3N0M0. It was considered to perform a partial maxillectomy by midfacial degloving approach. Results: The postoperative hospital stay was 3 days and there were not any complications or recurrence to date. Conclusions: The approach to midface degloving and partial maxillectomy allows en-bloc resection of sinonasal tumor with wide margins; and prosthetic reconstruction gives a rapid rehabilitation of masticatory function and phonation resonance.


10.29007/lrvd ◽  
2018 ◽  
Author(s):  
Zheng Guo ◽  
Hong-Bin Fan ◽  
Jun Fu ◽  
Xiao-Kang Li ◽  
Yu-Lin Hao

From December 2010 to May 2016, 8 patients with periacetabular tumor (chondrosarcoma 5 cases and GCT 3 cases) were treated by accurate en-bloc resection and precise reconstruction with a novel 3D printing individualized prosthesis.One case suffered dislocation of hip joint and two cases presented deep venous thrombosis. The mean follow-up period was 37.5 months (range, 5-70 months). 6 patients survived free of disease. One patient was subject to local recurrence after one year. One patient died from distal metastasis after three years. No infection, prosthesis loosening and breakage occurred. The MSTS score was 18~27. Our study suggest 3D printing implants might be a promising approach for precision reconstruction and long-term stability.


Endoscopy ◽  
2021 ◽  
Author(s):  
Hugo Uchima ◽  
Alberto Diez-Caballero ◽  
Jaume Capdevila ◽  
Mercé Rosinach ◽  
Alfredo Mata ◽  
...  

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