Ogino Akihiro, Onishi Kiyoshi, Nakamichi Miho, Okaneya Tetsuya
Department of Plastic and Reconstructive Surgery, Toho University Omori Medical Center, Tokyo, Japan.
J Craniofac Surg. 2018 Jan;29(1):156-158. doi: 10.1097/SCS.0000000000004075.
Nasal bone osteotomy subjectively judges the position for osteotomy by visual inspection and by manual feel using the fingertip. Therefore, the outcome depends on the surgeon's experience and mastery of the procedure is technically challenging.
The authors applied a navigation system for the intraoperative evaluation of the osteotomy line and reduction position in 5 patients with malunited nasal bone fracture. The authors performed the operation with a temporal bone post developed for otologic surgery using Stealth Station S7 System (Medtronic, Minneapolis, MN). The suretrack is attached to the bone chisel. The authors performed the osteotomies while visualizing the tip of the chisel on the monitor.In addition, evaluation of the reduction position was performed by insertion of a 23G needle syringe with the suretrack to the nasal bone surface.
The tip of the bone chisel was visible on the monitor, and the authors could perform osteotomies while confirming the position and direction of osteotomy. In addition, the reduction position could be visualized clearly on the monitor.
Navigation systems can confirm the 3-dimensional spatial relationship around the fracture site in real time, requiring only comparatively simple preoperative preparation and intraoperative operation without radiation exposure. Therefore, the advantage is that even an inexperienced surgeon can perform an accurate evaluation. This would be useful as a guide for young doctors and medical students as it would be possible to perform safe and accurate osteotomy for old nasal bone fractures.
鼻骨截骨术通过视觉检查和用指尖手动触摸来主观判断截骨位置。因此，手术结果取决于外科医生的经验，且掌握该手术在技术上具有挑战性。
作者对5例鼻骨骨折畸形愈合患者应用导航系统进行术中截骨线及复位位置评估。作者使用美敦力公司（明尼阿波利斯，明尼苏达州）的Stealth Station S7系统，采用为耳科手术开发的颞骨柱进行手术。将SureTrack附着于骨凿上。作者在监视器上可视化骨凿尖端的同时进行截骨术。此外，通过将带有SureTrack的23G针头注射器插入鼻骨表面来评估复位位置。
骨凿尖端在监视器上可见，作者能够在确认截骨位置和方向的同时进行截骨术。此外，复位位置在监视器上能够清晰地可视化。
导航系统能够实时确认骨折部位周围的三维空间关系，仅需要相对简单的术前准备和术中操作，且无辐射暴露。因此，其优势在于即使是经验不足的外科医生也能进行准确评估。这对于年轻医生和医学生将是有用的指导，因为对于陈旧性鼻骨骨折能够进行安全、准确的截骨术。
