When Ravi S (name changed), 53, from Indore, walked into a Bengaluru hospital with mouth ulcer, doctors decided to do an MRI since it was recurring frequently. The report showed a much more extensive tumour than anticipated. It was a challenge for the doctors to identify clear margins of the tumour, which also meant a significant part of the tongue would have to be removed. It was then that the team decided to bank on a Make-in-India device.
The cost-effective technology using 3D printing helped the surgeons visualize the tumour and plan its removal in a better way, all thanks to surgical oncologist Dr Vishal Rao U S whose motto is not to depend much on the West for medical solutions. He’s known for his invention -a voice box costing just Rs 50 for throat cancer patients who have lost their speech.
“A Mumbai-based company, Anatomiz 3D, helped us with a customized solution.They took a printout of the tongue and tumour, creating a simple colour demarcation to help the team plan the surgery to recreate the tongue.The team headed by Dr Prashanth Puranik recreated an exact replica of the tongue using the template model from the thigh muscles,” explained Dr Rao, chief of the head and neck surgical oncology department at HCG Cancer Hospital.
In this case, an MRI was utilized for designing. The tongue and tumour were segmented as two different parts and printed in two different colours for easy identification. The 3D printed model helps doctors and other medical experts understand the 3-dimensional anatomy of the part in question, and the depth, position and size of the tumour, he added.
3D printing in cancer surgery is a new technology , mostly used for bone reconstruction or orthopaedic surgery, said oncologists. Soft tissue 3D printing has been attempted in cardiology to understand congenital defects.”This is the first time globally, to the best of our knowledge, that such a procedure has been performed using flexible material differential 3D printing for soft tissues of the tongue,” the doctor added.
It helps surgical oncologists convert the 2D picture of MRI PET CT scan into a 3D visible model, which can aid better planning of tumour removal.Generally, surgeons use palpation technique with 2D image to create a mental picture of the tumour, which they may not see fully. The 3D model also helps plastic surgeons know the extent of the defect and simultaneously create a plan for the type and amount of tissues they would need to reconstruct. Usually, it is difficult to explain the problem to the patient through the MRI film due to lack of medical interpretation. 3 This is where the 3D model comes handy.
India battles high prevalence of oral cancer mainly due to tobacco chewing. Contrary to common perception, use of smokeless tobacco affects users as alarmingly as cigarettes. Keeping tobacco in the mouth, often considered harmless among the rural populace, is one of the main causes of tongue cancer. In a country where 4 in 10 of all cancers are oral cancers, low-cost medical experiments like this will be of great help. In many cases, in the absence of a clear view of the tumour, doctors are left with no option but to remove a major part of the tongue. The 3D printing technology addresses this challenge. This must be made widely available so that more people benefit from it.