Effect of Navigation System on Removal of Foreign Bodies in Head and Neck Surgery

Surgical Navigation Applied in Removal of Glass Located Under Zygomatic Arch

The limited detection rate of plain radiography (as low as 75%) for glass particles within the softs renders the conventional C-arm visualization method ineffective in intraoperative scenarios. The authors report the successful use of intraoperative navigation to visualize and extract multiple small glass fragments located deep within the temporal fossa and beneath the zygomatic arch. A 25-year-old man presented with a deep facial laceration, suspected injury to the temporal branch of the facial nerve, and a 2×2 cm foreign body beneath the sphenoid bone near the left zygomatic arch. The initial surgery removed most of the glass; however, two 4 mm fragments remained near the skull base. Using intraoperative navigation, a 3 cm incision was made, and a navigating stylet was used to locate and remove the foreign bodies. In conclusion, intraoperative navigation is a precise method for removing small, imperceptible glass fragments from challenging anatomic areas, thus reducing the need for extensive dissection compared to conventional approaches.

Preliminary Study of the Treatment Strategy for Retaining Traumatic Foreign Bodies Involving the Carotid Artery

PURPOSE

Craniomaxillofacial trauma is usually accompanied by indwelling foreign bodies, and some of those are close to the carotid artery, which increases the risks and difficulties of surgical treatment. The introduction of interventional radiology combined with image-guided surgical navigation may be a good solution for precise surgery to remove foreign bodies.

PATIENTS AND METHODS

Four patients were included in the study. All patients underwent digital subtraction angiography and enhanced computed tomography before surgery. The patients were divided into 3 categories (A, B, and C) according to the presence of carotid artery damage and its positional relationship with the foreign body, and 3 corresponding treatment strategies were developed. Treatments were completed using interventional radiology and surgical navigation systems.

RESULTS

All foreign bodies were completely removed, except for 1 remaining in the jugular foramen in a patient. The prognosis of all patients was good, and no systemic complications occurred.

CONCLUSION

The combined interventional radiology and surgical navigation method proposed in this study is an effective method to improve the accuracy and safety of foreign body removal surgery.

Utilizing a Nasal Speculum in Maxillofacial Trauma and Deep Space Neck Infections: A Technical Note

Maxillofacial trauma and odontogenic infections demand surgical access to sites often distant from wounds or incisions. We describe a simple, cost-effective, safe, and easy-to-implement technique of using a nasal speculum to facilitate surgical access in deep wounds of the head and neck region. This manuscript will describe 2 common indications and the technique for employing the nasal speculum as an adjunctive tool in oral and maxillofacial surgery.

Foreign body removal with the assistance of ultrasound guidance and methylene blue staining in children-a cohort study

BACKGROUND

Soft tissue foreign bodies (FBs) are very commonly observed in paediatric emergency departments. Not all FBs can be removed effectively, even via open surgery and image intensifier guidance. In the current study, we evaluated the efficiency of FB removal with the assistance of ultrasound (US) and methylene blue (MB) staining.

METHODS

We enrolled 80 patients at our clinical center between May 2016 and December 2020. Eleven patients were operated upon with the assistance of US guidance and MB and were defined as group A; the other 69 patients were defined as group B. For the patients in group A, US was first used to locate the FB; MB was then injected next to the FB. Open surgery was subsequently performed. For group B, the FBs were removed by conventional methods. The surgical outcomes were evaluated according to surgical duration, incision infection rates, radiograph exposure times, and FB residue rates.

RESULTS

The average surgery time for group A was 0.35 ± 0.10 hours; the corresponding time was 0.49 ± 0.50 hours in group B and there was a significant difference between the groups (p = 0.032). The radiograph exposure times were 1.33 ± 0.34 in group A and 4.65 ± 1.81 times in group B (p = 0.021).

CONCLUSIONS

This study demonstrates that assistance of US and MB staining is a more efficient approach compared with traditional methods for FB removal, and this surgical method can be used effectively for FB removal in children.

A rare case report of impacted foreign body (Sewing Needle) in upper neck

The Rationale

A 19-year-old female presented to the Otorhinolaryngology Department.

Patient Concerns:

Pain over the right side of the neck below the angle of the mandible following a fall on a pin cushion after a fight with her brother. She reported that the wound might have been caused by a sewing needle lodged in the pin cushion.

Diagnosis:

X-ray soft-tissue neck lateral view revealed a radiopaque linear shadow on the right side of the neck at the level of the C1-C2 vertebrae. On contrast-enhanced computed tomography, a linear (needle-like) foreign body at the level of C1-C2 was approximately 1.6 cm deep from the skin. The internal jugular vein seemed to be compressed between the needle and vertebrae.

Treatment:

Foreign body was explored and removed under general anaesthesia by an open lateral cervical approach.

Outcomes:

The patient’s postoperative recovery was uneventful.

Take-away Lesson:

Due to early diagnosis, management, and a team of experienced surgeons, anaesthesiologists, and support staff, any morbidity or mortality was avoided.

Imaging foreign bodies in head and neck trauma: a pictorial review

Open injuries bear the risk of foreign body contamination. Commonly encountered materials include gravel debris, glass fragments, wooden splinters or metal particles. While foreign body incorporation is obvious in some injury patterns, other injuries may not display hints of being contaminated with foreign body materials. Foreign objects that have not been detected and removed bear the risk of leading to severe wound infections and chronic wound healing disorders. Besides these severe health issues, medicolegal consequences should be considered. While an accurate clinical examination is the first step for the detection of foreign body materials, choosing the appropriate radiological imaging is decisive for the detection or non-detection of the foreign material. Especially in cases of impaired wound healing over time, the existence of an undetected foreign object needs to be considered.

Here, we would like to give a practical radiological guide for the assessment of foreign objects in head and neck injuries by a special selection of patients with different injury patterns and various foreign body materials with regard to the present literature.

Detectability of foreign body materials using X-ray, computed tomography and magnetic resonance imaging: A phantom study

PURPOSE

To evaluate the effectiveness of plain radiography (X-ray. XR), computed tomography (CT) and magnetic resonance imaging (MR) in visualising commonly seen foreign bodies. A special focus was put on objects relevant to head and neck surgery.

METHOD

Thirty-four commonly encountered objects of different compositions including wood, plastic, and glass were embedded in a gelatin gel phantom and imaged using XR, CT and MR. The success rates of radiologists in detecting and correctly identifying the foreign objects were evaluated. Subjective visibility was rated on a 4-point Likert scale. Objective visibility was analysed using region of interest-based contrast for CT.

RESULTS

Sensitivity in foreign bodies detection was highest in MR (97.1 %) followed by CT (86.0 %) and x-ray (61.8 %). Success rates for the correct identification of the objects and material types were highest in MR (33.3 % and 39.2 %, respectively) followed by CT (25.5 % for both) and XR (16.7 % and 15.7 %). Overall, subjective visibility was rated higher in CT and MR imaging ("good visibility"), as compared to XR ("poor visibility"). Interreader agreement was high across modalities (Kendall's W = 0.935, 0.834 and 0.794 for XR, MR and CT, respectively).

CONCLUSIONS

Detection and identification of non-ferromagnetic objects was most successful in MR followed by CT imaging in this experimental setup.

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.

Optical surgical navigation-assisted removal of a foreign body using a splint to simplify the registration process: a case report

Background

Oral and maxillofacial surgeons often encounter foreign objects within the human body. Despite the visual identification of foreign objects via imaging techniques, the accurate determination of their position in the maxillofacial area can be challenging. The clinical application of a navigation system can solve this issue. This system provides a useful guide for a safer and more accurate surgical technique by accurately determining the location of the lesion in real time during the surgery. However, complications with regard to registration may be encountered. We describe a navigation system that simplifies registration using a dental splint with embedded reference points for foreign body removal in the maxilla.

Case presentation

A 78-year-old Japanese woman was referred with the chief complaint of pain in the left upper molar region. We found the symptoms to be associated with a foreign body in the maxilla and decided to remove it. A minimally invasive treatment procedure was desirable. However, the lesion was in contact with the maxillary sinus, and it was difficult to pinpoint its position because of the absence of an anatomical landmark. Therefore, we decided to use a navigation system. In order to simplify registration, a dental splint with embedded reference points was created. The registration could be reliably performed before surgery using an optical navigation system that facilitates the process, using splints with embedded reference points. Following preoperative registration, the splint with the reference frame was placed in the patient’s mouth, and the accuracy of the navigation was confirmed. The position with respect to the maxillary sinus was precisely identified followed by the removal of the surrounding bone and excision of the lesion. Therefore, the surgery could be accurately performed without perforating the maxillary sinus. In addition, owing to preoperative registration, the operative time could be shortened. After the surgical procedure, the patient’s symptoms disappeared.

Conclusions

The procedure was performed in a precise, minimally invasive manner. Furthermore, the operative time was reduced by the simplified registration process, wherein a splint was embedded with reference points. This technique may prove useful for performing maxillofacial surgical procedures.

Multiple foreign bodies in the facial region from a penetrating stab injury

Penetrating injuries can lead to multiple retained foreign bodies. To present a case of a penetrating stab injury on to the right orbital region of a 37-year-old woman which resulted in lacerations on both eyelids, loss of vision in addition to the retention of glass particle and woven artificial hair strands at the anterior end of the floor of the orbit. The woven artificial hair strand, being flexible in nature, was apparently logged in by the penetrating force of the broken glass used as the stab injury object. Under local anaesthesia, a gentle intermittent pull on one hair strand led to the dislodgement of a piece of broken glass particle along with the other end of the hair strand. The resultant wound was repaired. Stab injuries can result in retained multiple foreign bodies. This possibility should be considered during assessment and management of facial injuries to avoid complications of retention.