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

A patient with squamous cell carcinoma of the maxillary sinus underwent a unilateral total maxillectomy and anterolateral thigh (ALT) free flap reconstruction. Post-surgery, a large maxillary defect without a bone graft led to midfacial collapse, exacerbated by radiotherapy. Given the aesthetic importance of 3-dimensional positioning in maxillary reconstruction, a mirror image was created using the normal contralateral side. The virtually reconstructed maxilla was evaluated for function and symmetry through computer simulation, facilitated by AVIEW Modeler. A surgical guide was created using a 3D printing system. Guided by this, a deep circumflex iliac artery (DCIA) free flap was harvested and implemented in the reconstruction, resulting in satisfactory outcomes. The usage of mirror image-based virtual surgical planning and 3D printed guides, as enabled by AVIEW Modeler, proved highly effective in maxilla reconstruction with DCIA flaps.