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The Use of CT Scans and 3D Printing To Plan for Challenging Cranio-Facial Surgeries.

We recently saw a few interesting cases that required very special diagnostic and surgical considerations.  In these cases, our surgeons implemented CT scans and or a combination of CT scans and 3D printing of the scans to come up with the most effective surgical plans for each.

One case, was a 7-year-old pug named Scotch, who had gone to his referring vet for a routine dental. During the procedure, a gingival mass was found above a tooth that had abscessed. The vet removed the tooth and found an oronasal fistula on the roof of his mouth. It was suspected that the tooth root abscess caused the fistula. The mass was removed as well, and sent out to a pathology lab. The results revealed a squamous cell carcinoma.

Scotch was then referred to Dr. Piscoya, a local oncologist, to discuss treatment options.  Knowing that squamous cell carcinomas send out microscopic tendrils beyond what the eye can see, there was concern that residual cancer was left behind.  Options considered included further surgical excision (to obtain additional surgical margin) or radiation therapy to put any remaining cancer into remission.  The client also saw Dr. Meleo, a local radiation oncologist,  to discuss the implications of the radiation therapy option. A CT scan of his skull was performed to help guide the decision, and after careful considerations, the clients decided they were interested in the surgical route.

With the CT scan in hand, Dr. Alex Aguila made a 3D print of it in order to come up with a surgical plan that would ensure that he could achieve adequate margins without having to take too much of Scotch’s hard palate or removing his eye. The black areas of the printed skull indicate the area that Dr. Aguila removed.

As it turns out, he was able to do both, thanks to technology and a network of great doctors!

The next case was a shaggy, 10-year-old shepherd mix named Hattie. Her owner noticed a hard bump above her left eye that just didn’t feel right, so she took her in to her vet to be checked out.  Her vet agreed with her assessment and referred her for a CT and biopsy of the mass. The preliminary results were consistent with osteosarcoma (bone cancer), so a radical surgical approach was necessary.

Armed with the CT, Dr. Allen Johnson made a 3D print of it and came up with a surgical plan that included removal of Hattie’s left eye as well as parts of her frontal, nasal and orbital bones. He also placed a graft of fibrous tissue over the surgical site, just under the skin to protect  the underlying structures. The excised bone was submitted to a pathology lab for further assessment.

The surgery, we’re happy to pronounce, was a complete success and the subsequent pathology report proved to be more consistent with a benign osteoma, so her owner was ecstatic with that news!

Lastly, was a case that Dr. Mike Thoesen had seen about a year ago. You might recall Dr. Thoesen as the surgeon who used the 3D prints of his own puppy’s CT scan to come up with a surgical plan to correct her congenital elbow defect. This case didn’t require a 3D print of the CT in order to come up with a plan, but a subsequent print of his skull proved to be quite impressive!

Pumpkin, a 10-year-old tabby cat, came to us for evaluation of a bony mass over his left zygomatic arch (the bony part of the eye socket) and the caudal maxilla (the back of the upper jaw). It had been present for about three years and didn’t seem to cause him any discomfort, but had recently grown dramatically in size. His owners were worried that he may lose his eye in the process, but they were very eager to have the mass removed ASAP. 

Dr. Thoesen performed a CT scan of Pumpkin’s skull and the images allowed him to see just where he would make his margin.  The surgery was such a success that he was able to completely excise the bony cyst while still saving his eye.

 

As you can imagine, Pumpkin’s owners are over the moon with the results of the surgery. And Pumpkin’s pretty happy as well!

 

The technological advances in veterinary medicine continue to amaze but none of these success stories would be possible without the coordination with our referring vets and the expertise of our skilled surgeons.


Posted January 19, 2019 by Animal Surgical in ASCS News with No Comments

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