Bone segment navigation: Difference between revisions

Revision as of 06:47, 24 July 2019

Revision as of 00:27, 25 November 2019

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After an accident or injury, a fracture can be produced and the resulting bony fragments can be displaced. In the oral and maxillofacial area, such a displacement could have a major effect both on facial aesthetics and organ function: a fracture occurring in a bone that delimits the [[orbit (anatomy)|orbit]] can lead to [[diplopia]]; a [[Human mandible|mandibula]]r fracture can induce significant modifications of the [[occlusion (dentistry)|dental occlusion]]; in the same manner, a skull ([[neurocranium]]) fracture can produce an increased [[intracranial pressure]].

In severe congenital malformations of the facial skeleton surgical creation of usually multiple<ref>{{Cite journal|last=Obwegeser|first=HL|date=1969|title=Surgical correction of small or retrodisplaced maxillae. The "dish-face" deformity.|url=|journal=Plast Reconstr Surg|volume=43|issue=4|pages=351–65|doi=10.1097/00006534-196904000-00003|pmid=5776622|access-date=|via=}}</ref><ref>{{Cite book|title=Craniofacial Surgery 3|last=Cutting|first=C|last2=Grayson|first2=B|last3=Bookstein|first3=F|last4=Kim|first4=H|last5=McCarthy|first5=J|publisher=Monduzzi Editore|year=1991|isbn=9788832300000|editor-last=Caronni|editor-first=EP|___location=Bologna|pages=|chapter=The case for multiple cranio-maxillary osteotomies in Crouzon's disease.|via=}}</ref> bone segments is required with precise movement of these segments to produce a more normal face.

== Surgical planning and surgical simulation ==

An [[osteotomy]] is a surgical intervention that consists of cutting through bone and repositioning the resulting fragments in the correct anatomical place. To insure optimal repositioning of the bony structures by [[osteotomy]], the intervention can be planned in advance and simulated. The surgical simulation is a key factor in reducing the actual operating time. Often, during this kind of operation, the surgical access to the bone segments is very limited by the presence of the soft tissues: muscles, fat tissue and skin - thus, the correct anatomical repositioning is very difficult to assess, or even impossible. Preoperative planning and simulation on models of the bare bony structures can be done. An alternate strategy is to plan the procedure entirely on a CT scan generated model and output the movement specifications purely numerically.<ref>{{Cite journal|last=Cutting|first=C|last2=Bookstein|first2=F|last3=Grayson|first3=B|last4=Fellingham|first4=L|last5=McCarthy|first5=J|date=1986|title=Three dimensional computer aided design of craniofacial surgical procedures: Optimization & interaction with cephalometric and CT-based models.|url=|journal=Plast. Reconstr. Surg.|volume=77|issue=6|pages=877–87|doi=10.1097/00006534-198606000-00001|pmid=3714886|access-date=|via=}}</ref>

== Materials and devices needed for preoperative planning and simulation ==

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== Clinical use of bone segment navigation ==

The first clinical report of the use of this type of system was by Watzinger et al. in 1997<ref>{{Cite journal|last=Watzinger|first=F|last2=Wanschitz|first2=F|last3=Wagner|first3=A|display-authors=etal|date=1997|title=Computer-aided navigation in secondary reconstruction of post-traumatic deformities of the zygoma.|url=|journal=J Craniomaxillofac Surg.|volume=25|issue=4|pages=198–202|doi=10.1016/s1010-5182(97)80076-5|pmid=9268898|access-date=|via=}}</ref> in the reposition of zygoma fractures using a mirrored image from the normal side as a target. In 1998 the system was reported by Marmulla and Niederdellmann to track LeFort I osteotomy position as well as zygoma fracture repositioning.<ref name=":0" /> In 1998 Cutting et al.<ref>{{Cite journal|last=Cutting|first=C|last2=Grayson|first2=B|last3=McCarthy|first3=J|display-authors=etal|date=1998|title=A virtual reality system for bone fragment positioning in multisegment craniofacial surgical procedures.|url=|journal=Plast Reconstr Surg|volume=102|issue=7|pages=2436–43|doi=10.1097/00006534-199812000-00027|pmid=9858182|access-date=|via=}}</ref> reported use of the system to track multisegment midface osteotomies in major craniofacial malformations.

== References ==