“Mirroring” Computational Planning, Navigation Guidance System, and Intraoperative Mobile C-Arm Cone-Beam Computed Tomography With Flat-Panel Detector: A New Rationale in Primary and Secondary Treatment of Midfacial Fractures?

Image guided surgical navigation integrating “mirroring” computational planning based on intra-operative cone-beam CT imaging: A promising new approach for management of primary bilateral midfacial fractures

“…As previously discussed, CAS has improved current surgical practices and patient outcomes in the treatment and prevention of such deformities [1][2][3][4][5][6][7][8][9][10][11][12][13]. The advantages and disadvantages of every reported technique implemented in the craniomaxillofacial area are already well documented in the literature and a detailed analysis is beyond the scope of this paper.…”

“…Over the last two decades, the use of Computer Assisted Surgery (CAS) has spread rapidly, dramatically improving the accuracy and predictability of numerous surgical procedures [1][2][3][4][5][6][7][8][9][10][11][12][13]. In the field of craniomaxillofacial surgery, the first applications of CAS date back to the late 1990s [4][5][6][7][8][9][10][11][12][13].…”

“…In the field of craniomaxillofacial surgery, the first applications of CAS date back to the late 1990s [4][5][6][7][8][9][10][11][12][13]. These focused primarily on secondary reconstruction of post-traumatic deformities following inadequate treatment of midfacial fractures.…”

“…These focused primarily on secondary reconstruction of post-traumatic deformities following inadequate treatment of midfacial fractures. In recent years, however, the subsequent development of a new generation of computational technologies has allowed pre-operative ''mirroring'' planning to be performed using the unaffected side as a template to predict the ideal and symmetric positioning of the bones on the affected side [8,10,13]. This technique can be coupled with intra-operative navigation guidance, thus allowing for ''real-time'' control of the restoration of facial symmetry in accordance with the prior computational planning.…”

“…This technique can be coupled with intra-operative navigation guidance, thus allowing for ''real-time'' control of the restoration of facial symmetry in accordance with the prior computational planning. Moreover, the integration within the operating room of mobile cone-beam computed tomography (CBCT), which in turn can also be coupled with the surgical navigation system and specific planning software, has improved intra-operative quality control, allowing immediate and rapid evaluation of the adequacy of the bone repositioning by means of image fusion [8,10,13]. While this sequential approach was Correspondence: Andrej Terzic, MD, DMD, Chief Resident, Division of Maxillofacial and Oral Surgery, Department of Surgery, University Hospital and Faculty of Medicine, 1211 Genève -Switzerland, .…”