Material and Methodology:
The study was done to evaluate the feasibility and role of a 3D
patient-specific biomechanical model for the management of tongue
tumour. The study was conducted at the HealthCare Global Enterprises
Cancer Centre, Bangalore, India. The technical support for developing
the 3D patient-specific biomechanical model was provided by Anatomiz3D
LLP, Mumbai, India.
In the present study two patients, diagnosed with Carcinoma Tongue,
sub-site lateral border of the tongue were included. These patients
underwent a pre-operative Magnetic Resonance Imaging (MRI) of the head
and neck region at our center. The images were acquired on a 3 Tesla
SIEMENS Skyra ® Magnetic Resonance Imaging machine without contrast with
48 channels in multi-planar, multi-sequence of head and neck region with
a pixel resolution of 0.9 x 0.9 x 0.9 mm3.
These patients were informed about the use of a 3D biomechanical
patient-specific model for treatment planning and execution and
consented for the same.
The data acquired by the MRI was obtained in a digital DICOM format.
Using Materialise Mimics Innovation Suite 19 ®, Belgium, an FDA, and CE
approved software DICOM data was imported, visualized, edited and
segmented. Open-source software, MakerBot MakerWare 2.4.1, Brooklyn NY
USA, was used to slice the 3D model, which serves as input data for the
3D Printer (Figure 1).
Flashforge ‘Creator-pro’3D Printer ®, Zhejiang, China was used. Fused
Deposition Modeling (FDM) technology was used to print the tumour and
uninvolved tongue in two different colors for easy identification.
Recreus Filaflex ® Elda, Spain flexible filament 1.75 mm spool was the
print material. The filament melts because of high temperature at the
nozzle and liquefied plastic is deposited on the print bed layer by
layer as the previous layer cools (Figure 2).
A team of Head and Neck Surgical Oncologist, Reconstructive surgeons,
Anaesthetist, Physician, and Speech-Language pathologist, preoperatively
evaluated the patients. The 3D biomechanical patient-specific tongue
model was used by the team to frame a treatment and rehabilitation plan
taking into account the patient preferences and needs.
These patients underwent a partial/ hemiglossectomy with neck
dissection. The 3D model served as a guide for margins. As a
preoperative assessment of volume loss was now possible, the
reconstructive team could simultaneously start the appropriate flap
harvest. The model also enabled accurate molding of the flap into the
surgical defect.
Oral swallow and speech rehabilitation were initiated from postoperative
day 3. One patient was able to take orally adequately, the nasogastric
tube was removed.