Surgical management of maxillofacial fibrous dysplasia under navigational guidance

Craniomaxillofacial Fibrous Dysplasia Improved Cosmetic and Occlusal Problem by Comprehensive Treatment: A Case Report and Review of Current Treatments

Fibrous dysplasia (FD) is a fibrous lesion of immature bone, with an incidence of 10–20% in the head and neck region. Most cases are monostotic, but when a lesion occurs on the maxillofacial region and spreads to the surrounding bone, it is classified as polyostotic, despite its localized occurrence. In some cases, surgical intervention is required to improve the cosmetic or functional disturbance of a FD in the maxillofacial region, but it is necessary to confirm symmetry of the maxillofacial region in real time, and a surgical support system is required to compensate. Furthermore, prosthetic intervention is considered when postoperative acquired defects occur or further cosmetic or occlusal function improvement is needed. A comprehensive approach by an oral surgeon and a maxillofacial prosthodontist is necessary for the successful treatment and rehabilitation of such patients. In this article, we describe the case of a craniomaxillofacial FD patient with facial asymmetry and denture incompatibility with improved quality of life measures by integrating surgical treatment using a navigation system and postoperative prosthetic rehabilitation. We also discuss recent diagnostic methods and treatment strategies for craniomaxillofacial FD in the literature.

Reduction of giant parietooccipital fibrous dysplasia using dynamic mirror image guidance: a case report and review of the literature

BACKGROUND

Craniofacial fibrous dysplasia (CFD) typically occurs in the facial bones and anterior cranial vault and can produce both disfigurement and functional limitations for patients disfigurement. Treatment consists of reducing the abnormal bone. Bone contouring can become challenging when the exposure does not extend to the corresponding normal contralateral structures for comparison or when normal landmarks are not available, which may compromise the overall aesthetic outcome. We describe a technique using dynamic mirroring to accurately contour the involved part of the cranium in a case of giant CFD.

OBSERVATIONS

A 49-year-old male presented with a giant deforming fibrous dysplasia of the right mastoid and parieto-temporo-occiput that was causing functional limitations due to the size of the bony mass. This was managed with multidisciplinary bony reduction. Several neurovascular structures were in proximity to the areas of planned drilling of the expansile lesion, and dynamic mirroring of the uninvolved left skull was utilized to maximize safety and symmetry of reduction. High-speed drilling of the right occipital bone was performed until the navigation system alerted the surgeon that symmetric depth had been achieved. There were no complications from the procedure and this technique maximized the limits of symmetric reduction without significantly increasing surgical complexity or duration.

LESSONS

Dynamic mirroring of bony structures in the posterior cranium is not commonly employed in neurosurgical practice. This technique may help improve the aesthetic outcomes of bony reduction in craniofacial dysplasia and a variety of similarly managed bony lesions, contour cranioplasties, and in unilateral craniosynostosis surgery.

Computer‐assisted and navigated piezoelectric surgery: A new technology to improve precision and surgical safety in craniomaxillofacial surgery

Background

Computer‐assisted navigated piezoelectric surgery (CANPS) is a surgical technique that combines the surgical navigation with a piezoelectric device. This association multiplies the advantages of both technologies, taking the best of each one providing a synergistic association.

Objective

To describe and assess the indications, advantages, disadvantages, and complications of this association of surgical techniques.

Methods

CANPS was used in 32 patients. The clinical diagnosis was facial trauma, tumors, orthognathic surgeries, temporomandibular joint ankylosis, pathology of the frontal sinus, and alveolar distraction. Nineteen patients were men and 13 were women. Planning software iPlan 3.05 of Brainlab, and Elements of Brainlab were used for planning and the Kolibri and Kurve of Brainlab for surgical navigation. The piezoelectric device used was a “Vercelotti” type in all patients.

Results

CAPNS could be performed successfully in all cases without complications and reduced the surgeon's uncertainty during the osteotomies. There is continuous control of the position of the surgical instrument. The use of the navigated piezoelectric device allowed the surgeon's uncertainty to be reduced during the performance of the osteotomies in depth, in poorly visible areas, with little access or reduced visibility. It also increases the safety of bone resections near important anatomical structures.

Conclusions

CANPS combines the advantages of piezoelectric surgery and navigation. CANPS affords real‐time control of the position of the cutting tip and allows semiburied approaches. CANPS allows surgery to be precise, safer, and minimally invasive.

Three-Dimensional Accuracy of Bone Contouring Surgery for Zygomaticomaxillary Fibrous Dysplasia Using Virtual Planning and Surgical Navigation

PURPOSE

Fibrous dysplasia (FD) is a benign condition in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. The present study aimed to estimate and compare the 3-dimensional (3D) accuracy of bone contouring surgery for zygomaticomaxillary FD performed using virtual planning and surgical navigation versus surgeon's intraoperative assessment.

PATIENTS AND METHODS

This is a retrospective cross-sectional study. Patients with zygomaticomaxillary FD who underwent bone contouring surgery between 2012 and 2019 were reviewed. They were divided into 2 groups: group A underwent bone contouring surgery using virtual planning and surgical navigation, and group B underwent bone contouring surgery by surgeon's intraoperative assessment. The predictor variable was surgical technique. The other variables were gender, age, and operative region. The primary outcome variable was 3D accuracy, which was indicated by root mean square, calculated as a measure of the deviation of the postoperative computed tomography from the preoperative virtual plan. The other outcome variables were patient satisfaction with the outcome by self-evaluation score and operative times. Correlation analysis between the predictor variables and outcome variables was performed.

RESULTS

The sample comprised 24 patients (17 males and 7 females, mean age, 25.7 ± 10.45 years), 13 patients in group A and 11 patients in group B. The mean root mean square was significantly lower in group A than in group B (P = .007). Patient satisfaction with facial symmetry was significantly better in group A (P = .015). Mean operative time was comparable between the 2 groups (P = .918). Surgical technique (P = .011) and operative region (P = .01) were significant influence factors in 3D accuracy of surgery.

CONCLUSIONS

Virtual planning and surgical navigation can significantly improve the 3D accuracy and patient satisfaction of bone contouring surgery for zygomaticomaxillary FD, without prolonging operative time.

Intraoperative Image-Guided Navigation in Craniofacial Surgery: Review and Grading of the Current Literature

INTRODUCTION

Image-guided navigation has existed for nearly 3 decades, but its adoption to craniofacial surgery has been slow. A systematic review of the literature was performed to assess the current status of navigation in craniofacial surgery.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) systematic review of the Medline and Web of Science databases was performed using a series of search terms related to Image-Guided Navigation and Craniofacial Surgery. Titles were then filtered for relevance and abstracts were reviewed for content. Single case reports were excluded as were animal, cadaver, and virtual data. Studies were categorized based on the type of study performed and graded using the Jadad scale and the Newcastle-Ottawa scales, when appropriate.

RESULTS

A total of 2030 titles were returned by our search criteria. Of these, 518 abstracts were reviewed, 208 full papers were evaluated, and 104 manuscripts were ultimately included in the study. A single randomized controlled trial was identified (Jadad score 3), and 12 studies were identified as being case control or case cohort studies (Average Newcastle-Ottawa score 6.8) The most common application of intraoperative surgical navigation cited was orbital surgery (n = 36), followed by maxillary surgery (n = 19). Higher quality studies more commonly pertained to the orbit (6/13), and consistently show improved results.

CONCLUSION

Image guided surgical navigation improves outcomes in orbital reconstruction. Although image guided navigation has promise in many aspects of craniofacial surgery, current literature is lacking and future studies addressing this paucity of data are needed before universal adoption can be recommended.

Fibrous Dysplasia treated with virtual planning - report of two cases

Fibrous dysplasia (FD) is part of a rare group of bone dysplasia. It exhibits benign behavior and can lead to osteolytic lesions, deformities, and fractures. The treatment is challenging, and accurate removal of the lesion is necessary to restore function and esthetics. Here we present two cases of FD where virtual planning with presurgical computed tomography (CT) was used for the production of a surgical guide for bone contouring. First, CT image reconstruction was performed to mirror the patient’s original anatomy. Then, three surgical guides that determined the area and depth of bone wear were prepared and used in the relevant sequence during the actual surgeries, which were successfully performed in both patients. This technique is termed the template guide holes (TGH) technique. The findings from this report suggest that presurgical virtual planning and guide preparation allows direct and objective measurement of the level of bone wear and improves the functional and esthetic outcomes of surgery for FD. In particular, the TGH technique is safe and allows adequate preoperative surgical simulation, reduces the surgical duration, and increases the predictability of the final result.

The Safety and Accuracy of Surgical Navigation Technology in the Treatment of Lesions Involving the Skull Base

OBJECTIVE

As compared with the normal anatomy, structures of the skull base and its surroundings have been dramatically altered of the lesion near the skull base. How to remove the lesion at the skull base was mainly depending on surgeon's personal experience during past years. In this study, the authors explored the safety and accuracy of the surgical navigation system in resecting lesions near the skull base.

METHODS

The surgical cases consisted of 15 patients who underwent surgery involving the skull base with the using of surgical navigation technology. Five patients had adenoid cystic carcinoma at minor salivary glands of the palate extending to the skull base and 10 patients were suffered from bony ankylosis of temporomandibular joint. After the system converted patient's computed tomography scans into three-dimensional reconstructive images, preoperative planning and simulation of the operation process could be made by surgeons. During the operation, the virtual images were matched with the patient through individual registration. The system provided surgeon with feedback about the operation on the screen instantly with moving the navigated pointer.

RESULTS

The application of surgical navigation system was safe and reliable for resecting the ankylotic bone and identifying the extent of tumors resection near the skull base. No complications including cerebrospinal fluid leak, cranial nerve injuries, severe bleeding happened to those patients.

CONCLUSIONS

Given the safety and accuracy of the surgical navigation system, surgery near the skull base appeared to be an ideal field for using with its complex anatomy.

Bone Recontouring by Guided Surgical Navigation Integrating “Mirroring” Computational Planning in the Management of Severe Fronto-orbital Asymmetry in Fibrous Dysplasia

We report the successful treatment of severe fronto-orbital asymmetry in a 20-year-old man with fibrous dysplasia by bone recontouring using a specific approach combining “mirroring” virtual computational planning with intraoperative guided surgical navigation.

Three-dimensional reconstruction with serial whole-mount sections of oral tongue squamous cell carcinoma: A preliminary study

OBJECTIVES

Margin status and invasion pattern are prognostic factors for oral tongue squamous cell carcinoma (OTSCC). Current methods to identify these factors are limited to 2D observation; it is necessary to explore 3D reconstruction with whole-mount sample to improve the accuracy of analysis. This study aimed to study the tissue preparation, section generation, and 3D reconstruction with whole-mount OTSCC specimen.

STUDY DESIGN

Two OTSCC samples were retrieved from Nanjing Stomatological Hospital, Medical School of Nanjing University. One sample was sliced into 3 equal-sized pieces and subjected to different processing schedules to determine the best method. The second sample was processed accordingly. Serial whole-mount sections of the second sample were generated, stained with HE/anticytokine antibody in intersection manner, and scanned into digital images. Digital images were aligned and reconstructed into 3D images with Hetero Genius Medical Image Manager 3D Pathology Add-On [HGMIM3D].

RESULTS

Successful serial whole-mount sections of comparable quality to traditional sections were generated. Three-dimensional images with serial whole-mount sections were successfully generated.

CONCLUSIONS

Whole-mount histopathological 3D reconstruction of OTSCC was successfully generated, providing a solid foundation for comprehensive margin and invasion analysis. Although future study and improvement were needed, whole-mount histopathological 3D reconstruction proved to be a promising method in OTSCC study.

Orthognathic Surgery: A Review of Articles Published in 2014-2015

OBJECTIVES

We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published.

METHOD

A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea.

RESULTS

Bulk of the studies were retrospective, and less interest was shown onto experimental researches.

CONCLUSION

A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.