Interdisciplinary Surgical Management of Multiple Facial Fractures With Image-Guided Navigation.

PURPOSE: To evaluate the effectiveness of interdisciplinary surgical management of multiple facial fractures with image-guided surgical navigation. PATIENTS AND METHODS: From 2011 through 2014, 36 patients with multiple facial fractures were enrolled in the study. With individual virtual 3-dimensional (3D) modeling, interdisciplinary planning and surgical simulation were carried out on an Accu-Navi software platform. Through an interactive collaboration among specialists, all patients underwent 1-stage open reduction under guidance of the navigation system. The outcome was assessed by superimposing the postoperative 3D computed tomographic (CT) model on the preoperative plan and clinical examination. RESULTS: Through the registration procedure, an accurate match between the actual intraoperative position and the CT images was achieved within a systematic error of 1 mm. The fractured bone segments were released and repositioned according to the preoperative plan and simulation with the aid of instrument- and probe-based navigation. All patients underwent uneventful healing without serious complications. Postoperative assessment of surgical intervention showed a quantitative discrepancy less than 2 mm (1.49 ± 0.27), showing a satisfactory concordance. CONCLUSION: In the interdisciplinary surgical management of multiple facial fractures, image-guided surgical navigation, including preoperative planning, surgical simulation, postoperative assessment, and computer-assisted navigation, proved an optimal strategy and valuable option for this potentially complicated procedure.

Navigation-guided correction of midfacial post-traumatic deformities (Shanghai experience with 40 cases).

PURPOSE: To evaluate the effectiveness of navigation-guided surgical correction as the treatment of midfacial post-traumatic deformities. PATIENTS AND METHODS: A total of 40 patients with midfacial post-traumatic deformities from 2007 to 2010 were involved in the present study. The preoperative planning and simulation data sets, including the generation of virtual models with the mirror tool, were used as a virtual template to guide surgical correction of those deformities by intraoperative instrument- and/or probe-based navigation. The outcome was checked by both superimposing the postoperative 3-dimensional computed tomography model on the preoperative planning model and clinical examination. RESULTS: Through registration, an accurate match between the intraoperative actual position and 3-dimensional virtual model was achieved with a systematic error of 1 mm difference. With the guidance of the navigation system, the average deviation of the morphologic change after surgical correction was less than 1 mm according to the image comparison between the preplanned and postoperative computed tomography. The 1- to 2-year follow-up evaluation showed that the clinical complaint symptoms were alleviated, and the postoperative function and esthetics improved remarkably. CONCLUSIONS: Navigation-guided correction in the treatment of midfacial post-traumatic deformities can be regarded as an ideal and valuable option for this potentially complicated procedure.

Real-time image-guided recontouring in the management of craniofacial fibrous dysplasia.

OBJECTIVE: This report presents our experience using computer-aided recontouring in the surgical management of complex craniofacial fibrous dysplasia with the use of a navigation system developed by the authors. STUDY DESIGN: A total of 21 patients (9 men and 12 women) with craniofacial fibrous dysplasia and mean age of 23 years (range, 17-32 years) were included in this study from 2007 to 2012. By creating a mirror image of the unaffected side on the affected side as a virtual treatment template, we completed the recontouring procedures in real time with the aid of the navigation system that we developed (Accu-Navi). The surgical outcome was assessed by superimposing the postoperative computed tomography (CT) images onto the preoperative CT images. RESULTS: The precise preoperative simulation and intraoperative navigation enabled the surgeon to complete the recontouring procedure visually. Postoperative CT was compared with the preoperative plan, yielding an average discrepancy of <1.0 mm. Postoperative follow-up found that both facial aesthetics and patient satisfaction improved remarkably. CONCLUSIONS: Navigation-guided recontouring shows benefits in improving accuracy and safety for this complicated procedure.