Safe and rapid contouring of fibro-osseous lesions in the orbital area using navigation with minimally invasive cranial bone registration.

BACKGROUND: Bone contouring is currently the best treatment for fibro-osseous lesions after bone growth arrest. Navigation systems available for this surgery allow intra-operative visualisation with improved cosmetic outcomes. However, conventional navigation systems using superficial skin registration cannot prevent subtle discrepancies. METHOD: To address this problem, we used a non-invasive cranial bone registration that uses patient-specific dental templates to maintain exact registration. We created the preset goal using the mirror image of the unaffected side for unilateral lesions, and using images obtained before the onset of symptoms for bilateral lesions. This system achieved precise pre-operative simulation. A sound aid in the navigation system provided information regarding proximity to critical structures and to the preset goal. RESULTS: We used this system to contour fibro-osseous lesions in three patients. All patients achieved good facial contours and improvement in symptoms. CONCLUSIONS: This method offers a safe, rapid surgical aid in treating orbital fibro-osseous lesions.

Internal jugular vein reconstruction: application of conventional type A and novel type K methods.

BACKGROUND: During neck dissection, the current practice is to preserve the internal jugular vein in the majority of cases. However, sacrifice of bilateral internal jugular veins is required in rare cases. Simultaneous excision of both internal jugular veins is known to frequently cause fatal complications. Even if staged, bilateral internal jugular vein sacrifice still occasionally leads to fatal complications (in 2 per cent). We report two different methods of unilateral internal jugular vein reconstruction, in two cases requiring excision of bilateral internal jugular veins, and we review the significance of this reconstruction procedure. METHOD: The first patient underwent conventional type A reconstruction (using Katsuno's classification): end-to-end anastomosis of the internal jugular vein to the external jugular vein. For the second patient, we anastomosed the internal jugular vein to the anterior jugular vein, preserving the flow of the external jugular vein. This method, termed type K, had two main expected benefits: facial drainage via the preserved external jugular vein; and provision of a built-in safeguard in the case of occlusion (via the preserved venous networks between the internal jugular vein and the external jugular vein, e.g. the facial vein). RESULTS: In both cases, the reconstructed internal jugular vein was patent and the post-operative course was uneventful, with no severe complications. CONCLUSION: The current and previous findings strongly indicate that the reconstruction of at least one internal jugular vein is highly recommended for patients requiring bilateral internal jugular vein sacrifice. Our type K method may represent a useful technique for this procedure.