Discussion:
The tongue is a dynamic organ and has often tricked the surgeon. A close
or positive margin has adverse implications on treatment outcome and
overall survival 6. With better imaging modalities the
surgeon can better assess the tumour extent. However, a real-time
assessment of tumour intra-operatively is far from reality. The decision
as to how much to resect is taken based on clinical judgment. Over
resection and margin positivity in the third dimension is always a
threat 7. The biomechanical 3D model used by us helps
the surgeon to get a real-time three-dimensional extent of the tumour.
In our study, we noted that resection was more accurate and resulted in
lesser chances of over resection.
Until recently, reconstructive surgeons designed free flaps by visually
estimating the defect and using basic geometric shapes. However, defects
following ablative procedures are considerably more complex. Today
CAD-CAM 3D printed models have increased the accuracy of reconstruction
in the management of bucco-alveolar complex tumours. A similar guide for
tongue tumour resection can help improve the efficacy of reconstruction8. Owing to the dynamic nature of the tongue, the
extent of functional restriction often relates to the extent of
resection 9. With a realtime model, the patient and
family can better visualize the tumour and understand the concept of
safe margin and possible extent of resection. This helps them better
prepare for the outcomes and functional deficits. With a wealth of
information available at a click of a button, the patients also prefer
to be fully prepared for the deficits to make an appropriate decision.
Due to incessant tobacco use amongst youngsters, the disease is now more
prevalent in the younger population. Functionally rehabilitating these
young patients accurately has definitive implications on quality of life
personally and professionally. Often the resected specimen is used as a
benchmark to plan the flap volume. A common problem encountered by
patients post-reconstruction is often due to preventable causes. The
flap bulk can restrict tongue movements, impair swallowing and
compromise of vocalization 10. The extra flap bulk
which is recommended can be optimized with the 3D model reducing the
chances of such problems.
Using the 3D model the rehabilitative team also can have a better
understanding of the resection and functional restriction. This helps in
developing better rehabilitative strategies 9.