A 49-year-old cancer survivor who developed a severe facial deformity following cancer treatment has undergone complex jaw reconstruction using 3D virtual surgical planning, a customized patient-specific titanium implant and a free anterolateral thigh flap. A multidisciplinary team led by Dr. Amit Chakraborty, Lead Head & Neck Surgical Oncologist at SSO Cancer Hospitals, Mumbai, performed the complex secondary reconstruction. The procedure aimed not only to restore the patient’s facial structure but also to improve essential functions such as eating, speaking and swallowing, thereby enhancing his overall quality of life.
Cancer Treatment Left Major Jaw and Facial Defect
The patient was diagnosed with Stage III carcinoma of the right buccal mucosa, the inner lining of the right cheek, in March 2024. He subsequently underwent extensive cancer surgery followed by multimodality treatment. However, after treatment, he developed a postoperative oronasal fistula, an abnormal opening between the mouth and nose that caused nasal regurgitation, along with a major defect involving the jaw and surrounding facial structures. As a result he faced considerable difficulty eating, speaking and swallowing. The facial deformity also affected his appearance, confidence and quality of life.
Reconstruction Planned After Confirming Cancer-Free Status
Before undertaking reconstruction, a PET-CT scan confirmed that the patient was currently disease-free, with no evidence of recurrence or metastasis. This allowed the medical team to focus on reconstructive rehabilitation. Dr. Amit Chakraborty explained that reconstruction was essential because the persistent oronasal fistula could otherwise lead to worsening nasal regurgitation, impaired chewing and swallowing, nutritional deterioration and progressive facial disfigurement. “The reconstructive objective was not simply to replace the missing jaw, but to restore facial architecture, symmetry, oral competence, mastication, speech, swallowing and appearance, helping the patient regain functional independence and confidence,” said Dr. Chakraborty.
3D Virtual Surgical Planning Enabled Precise Reconstruction
The reconstruction presented significant challenges because the surgical site had previously undergone cancer surgery and radiotherapy. Consequently, the patient had severe radiation fibrosis, distorted tissue planes, restricted mouth opening and potentially compromised recipient blood vessels. To address these challenges, the surgical team used 3D virtual surgical planning before the operation. This enabled the surgeons to visualize the facial defect, assess asymmetry and determine the desired reconstructive contour in advance. Using the patient’s CT-derived DICOM data, the team digitally designed a customized, biocompatible patient-specific titanium implant. The implant was created to reproduce the patient’s individual mandibulofacial anatomy and restore the missing jaw structure with greater precision.
Customized Titanium Implant Combined with Microsurgical Reconstruction
The patient-specific titanium implant was combined with a left free anterolateral thigh flap, which provided vascularized soft-tissue coverage for the reconstruction. The customized implant was prepared four days before surgery, allowing the surgical team to plan the procedure in detail and improve intraoperative accuracy. Dr. Chakraborty said the procedure was particularly demanding because of the previous surgery and radiation treatment. “Three-dimensional virtual surgical planning allowed us to analyse the patient’s native craniofacial anatomy and contralateral symmetry before surgery and digitally recreate the desired facial projection and contour. A customized titanium patient-specific implant was then designed from his CT data to achieve greater anatomical accuracy, predictability and reproducibility during reconstruction,” he said. Unlike conventional reconstruction, which may depend more heavily on intraoperative estimation and manual implant bending, patient-specific 3D planning allowed the team to determine the desired anatomy before surgery.
Successful Recovery and Ongoing Rehabilitation
The procedure was completed successfully. However, because of the previous radiation, fibrosis, altered tissue planes, limited mouth opening and changes in the recipient vessels, the reconstruction required meticulous surgical planning and execution. Following surgery, Ryle’s tube feeding was continued for approximately two weeks to protect the intraoral reconstruction, reduce stress on the suture line and support tissue healing. The patient was discharged on 30 August 2026 and is now undergoing structured follow-up at one week, two weeks, one month and subsequently as part of ongoing oncological and reconstructive surveillance. As per the press release, rehabilitation will focus on progressively improving mastication, speech and swallowing, with the broader goal of helping the patient regain functional independence and return to normal daily activities.