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.