光学导航技术在口腔颌面深部间隙异物取出术中的应用

Application of optical navigation in removal of foreign bodies in the oral and maxillofacial deep space

目的:探讨光学导航技术应用于口腔颌面深部异物留置取出术的适应条件和临床价值。方法:对5例口腔颌面部外伤后异物留置于深部间隙的患者在导航辅助下行异物取出术,术前进行三维CT和数字减影血管造影检查,对异物进行空间定位,并将CT的Dicom数据导入STN导航系统中,用于术前手术规划和术中导航。术中观察导航系统的实时性和精确性,评价导航技术对口腔颌面部深部间隙异物取出的有效性。结果:在光学导航技术辅助下,5例留置的异物均能通过微创入路顺利定位和取出,术中未发现神经、血管损伤,术后亦未发现感染、呼吸困难等并发症。术后随访3～12个月,患者主诉症状均缓解,功能和面型取得了满意的效果。结论:光学导航技术在口腔颌面深部间隙异物取出术中的应用,尤其在解剖位置复杂和危险的区域,可以提高手术的精确性、微创性和安全性。

PURPOSE： To determine the indications and clinical values of optical navigation applying in removal of foreign body in the oral and maxillofacial deep space. METHODS： Under the intraoperative navigation, 5 patients with foreign bodies retained in the oral and maxillofacial deep space after trauma had the objects removed in this study. Preoperative 3- dimensional CT scanning and digital subtraction angiography （DSA） were undertaken to define the accurate spacial location of the foreign bodies. The digital imaging and communications in medicine （Dicom） data was inputted into the STN navigation system（Stryker-Leibinger, Freiburg, Germany） in order to obtain preoperative surgical plan and intraoperative navigation. The efficiency of navigation-guided removal of foreign bodies was evaluated by observing the real-time and accuracy of optical navigation intraoperatively. RESULTS： Assisted by the optical navigation, all of 5 patients had the foreign bodies located and removed successfully through a minimally invasive incision. No intraoperative neurovascular injuries and postoperative complications were noted. During 3 to 12 months of follow-up, the symptoms of chief complaint were alleviated and the postoperative function and esthetics improved remarkably. CONCLUSIONS： Application of optical navigation in removal of foreign bodies in the oral and maxillofacial deep space, especially in complex and dangerous anatomic region related to the strategic sites, was able to improve the surgical accuracy and safety in minimally invasive approach. Supported by Key Projects of Science and Technology Commission of Shanghai Municipality （11441902200）,and Combined Engineering andMedicine Project of Shanghai Jiao Tong University（YG2011MS06）.