Liu Tom J, Ko An-Ta, Tang Yueh-Bih, Lai Hong-Shiee, Chien Hsiung-Fei, Hsieh Thomas Mon-Hsian
From the Department of Surgery, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ann Plast Surg. 2016 Apr;76(4):411-9. doi: 10.1097/SAP.0000000000000429.
Intraoperative navigation is a tool that provides surgeons with real-time guidance based on patients' preoperative imaging studies. The application of intraoperative navigation to neurosurgery and otolaryngology has been well documented; however, only isolated reports have analyzed its potential in the field of craniomaxillofacial surgery.
From November 2010 to July 2014, 15 patients were operated on for complex craniomaxillofacial surgery with assistance by 3 different navigation systems, which used either infrared or electromagnetic technologies. We imported fine-cut (0.625-mm) computed tomographic scan images of the patients to the navigation systems whose software processed them into multisurface 3-dimentional models used as guiding material for the surgical navigation. We also developed a simple "2-plane reference system" to ensure that the final results were symmetric to the normal half of the face. Appearance outcome was evaluated by questionnaire.
Of these 15 cases, 3 cases were performed with infrared-based navigation, and the remaining 12 cases were accomplished by electromagnetic technology. Most of these cases resulted in satisfactory outcomes after tumor resection, posttraumatic reconstruction, and postablative reconstruction.
Navigation systems offer highly valuable intraoperative assistance in complex craniomaxillofacial surgery. Not only can these systems pinpoint deep-seated lesions as neurosurgeons or otolaryngologists do, but they can also use a simple 2-plane reference system for accurate bone alignment. Moreover, advancements in multisurface 3-D models provide us more reliable intuitive image guidance. The application of electromagnetic technology, with its smaller reference obviation of the line-of-sight problem, makes the manipulation of craniomaxillofacial surgery more comfortable.
术中导航是一种基于患者术前影像学检查为外科医生提供实时引导的工具。术中导航在神经外科和耳鼻喉科的应用已有充分记录；然而，仅有个别报告分析了其在颅颌面外科领域的潜力。
2010年11月至2014年7月，15例患者在3种不同的导航系统辅助下接受了复杂的颅颌面外科手术，这些系统采用了红外或电磁技术。我们将患者的薄层（0.625毫米）计算机断层扫描图像导入导航系统，其软件将这些图像处理成多表面三维模型，用作手术导航的引导材料。我们还开发了一种简单的“双平面参考系统”，以确保最终结果与面部正常半侧对称。通过问卷调查评估外观结果。
在这15例病例中，3例采用基于红外的导航进行手术，其余12例通过电磁技术完成。这些病例大多在肿瘤切除、创伤后重建和切除后重建后取得了满意的结果。
导航系统在复杂的颅颌面外科手术中提供了极有价值的术中辅助。这些系统不仅能像神经外科医生或耳鼻喉科医生那样精确找到深部病变，还能使用简单的双平面参考系统进行精确的骨对齐。此外，多表面三维模型的进步为我们提供了更可靠、直观的图像引导。电磁技术的应用减少了视线问题的参考偏差，使颅颌面外科手术操作更加便捷。
