Computed tomography navigation combined with endoscope guidance for the removal of projectiles in the maxillofacial area: a study of 24 patients

Evidence-Based Medicine for Ballistic Maxillofacial Trauma

Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.

Needle Removal in the Deep Maxillofacial Region Assisted by Computerized Navigation Technique and Digital Guiding Plate

Retention of foreign bodies frequently happened in the region of oral and maxillofacial. In very rare cases, the positions of the foreign objects moved with the movement of muscles in the oral and maxillofacial regions. Precise locations of moving objects and minimally invasive surgeries pose a great challenge to surgeons. The case of a 44-year-old female patient diagnosed with retention of the fractured needle is reported in this study. A digital guide plate was manufactured to locate the precise position of the fractured needle and preoperatively mimic the surgery processes. The computerized navigation system guided us to make an incision and precisely target the fractured needle during the surgery. Combing the technologies of the digital guiding plate and navigation system, removing the moving foreign bodies becomes objective, time-saving, and minimally invasive.

Image-guided surgery in otolaryngology: A review of current applications and future directions in head and neck surgery

Image-guided surgery (IGS) has become a widely adopted technology in otolaryngology. Since its introduction nearly three decades ago, IGS technology has developed rapidly and improved real-time intraoperative visualization for a diverse array of clinical indications. As usability, accessibility, and clinical experiences with IGS increase, its potential applications as an adjunct in many surgical procedures continue to expand. Here, we describe the basic components of IGS and review both the current state and future directions of IGS in otolaryngology, with attention to current challenges to its application in surgery of the nonrigid upper aerodigestive tract.

New Solutions to Improve the Accuracy of the Navigation-Guided Foreign Body Removal in Craniomaxillofacial Deep Space

OBJECTIVE

Surgical navigation-guided removal of foreign bodies in the craniomaxillofacial region has been proven to be an effective method. However, there have been some unsuccessful patients due to reduced navigation accuracy or complicated and undetectable anatomy. This article summarizes the experience and proposes some solutions to achieve better results.

STUDY DESIGN

Two solutions were proposed to optimize the surgical navigation procedure: using a 3-dimensionally printed customized mandible retainer to indirectly maintain the consistency of the foreign body's visual images of preoperative planning and intraoperative navigation and importing real-time endoscopic imaging during surgery to provide vision under complex anatomy. Two patients were selected for each method.

RESULTS

The foreign bodies were successfully and minimally invasively removed in all patients assisted by optimized surgical navigation. During follow-up at 3 to 6 months postoperatively, no complications were found.

CONCLUSION

Improving navigation accuracy and providing real vision might be effective at compensating for insufficient navigation due to navigation positioning errors or the interference of imperceptible and complicated anatomy.

Surgical Navigation for Oral and Maxillofacial Surgery

This article reviews the basic setup and function of surgical navigation and displays a variety of applications in oral and maxillofacial surgery. The use of surgical navigation for dental implant placement is discussed elsewhere in this issue.

Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery

PURPOSE

This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications are discussed.

MATERIALS AND METHODS

A systematic search in relevant electronic databases, journals, and bibliographies of the included articles was carried out. Clinical studies with 5 or more patients published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal were the areas of interests.

RESULTS

The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups.

CONCLUSIONS

SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve.