Implementation of a miniaturised navigation system in head and neck surgery for the detection and removal of foreign bodies

Abstract

The removal of embedded blast-generated fragments from soft tissue is very difficult, especially in the head and neck regions. First, because many retained foreign materials are non-metallic and can, therefore, not be detected by fluoroscopy, and second, because a broad exploration of the soft tissue is not possible in the facial area for functional and cosmetic reasons. Intraoperative navigation computer-assisted surgery (CAS) may facilitate the retrieval of foreign bodies and reduce exploration trauma. In a blind trial, five test specimens of different materials (glass, metal, wood, plastic, and stone) were inserted on the left and right sides of the head and neck of ten body donors through an intraoral incision. A second physician then detected and removed the foreign bodies from one side of the body without and from the other side of the body with navigation. We measured the duration of surgery, the extent of tissue trauma caused during surgery, the time it took to remove the foreign bodies, and the subjective evaluation of the usefulness of navigation. With the aid of the navigation system, the various foreign bodies were detected after an average of 26.7 (±35.1) s (p < 0.0001) and removed after an average of 79.1 (±66.2) s (p = 0.0239), with an average incision length of 10.0 (±3.5) mm. Without the navigation system, the foreign bodies were located after an average of 86.5 (±77.7) s and removed after an average of 74.1 (±45.9) s, with an average incision length of 13.0 mm (±3.6) mm (=0.0007). Intraoperative navigation systems are a valuable tool for removing foreign bodies from the soft tissue of the face and neck. Both the duration of surgery and the incision length can be reduced using navigation systems. Depending on the material of the foreign bodies and the signal intensity in the CT/MRI scanner, however, the detection reliability varies. All in all, navigation is considered to be a useful tool.

Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge

“…In cases where the object is not directly visible by imaging, attention should be paid to indirect signs including air bubbles, excessive soft tissue swelling, or abscess formation. In addition to the preoperative evaluation, intraoperative navigation and X-ray by C-arm provides excellent additional support for localization, as well as for the removal of debris particles from the soft tissue, including shotgun projectiles ( case 3 ) 26…”

“…In addition to the preoperative evaluation, intraoperative navigation and X-ray by C-arm provides excellent additional support for localization, as well as for the removal of debris particles from the soft tissue, including shotgun projectiles (case 3). 26…”

Surgical Navigation Applied in Removal of Glass Located Under Zygomatic Arch

“…2 While HA injections are generally deemed safe, there have been rare reports of serious complications such as vascular embolism, cerebral infarction, and visual impairment. 3 We recently encountered a patient with a prior history of HA injections who developed a severe septal ulcer secondary to local ischemia due to arterial occlusion after the HA nasal filler injection. The condition was identified with the aid of nasal endoscopy and imaging studies.…”

“…These foreign bodies encompass a spectrum of materials, including metals, plastic, and glass, all of which can be readily discerned using radiographic imaging. 3 If these foreign materials are not detected by appropriate imaging tests, their removal becomes considerably more challenging. The detection rate of glass with plain radiography is as low as 75% which means that x-rays miss 25% of glass particles.…”

“…In cases in which conventional plain radiography can effectively identify a foreign body, C-arm fluoroscopy can offer invaluable intraoperative real-time insights into the precise localization of misplaced foreign objects within the intricate anatomic landscape of the head and neck. These foreign bodies encompass a spectrum of materials, including metals, plastic, and glass, all of which can be readily discerned using radiographic imaging 3 …”