Three-Dimensional Accuracy of Bone Contouring Surgery for Zygomaticomaxillary Fibrous Dysplasia Using Virtual Planning and Surgical Navigation

This study aimed to propose a novel surgical technique, named multiple tangential shaving of bone contour, for the conservative management of craniofacial fibrous dysplasia. We retrospectively reviewed 17 patients who underwent conservative management of craniofacial fibrous dysplasia using multiple tangential shaving technique between July 2005 and December 2020. Demographics, tumor characteristics, and surgery-related factors were investigated. All patients underwent preoperative (T0) and postoperative computed tomography scans taken at least twice within 1 month for immediate assessment (T1) and at least 12 months postoperatively for longterm assessment (T2). Clinical outcomes, including tumor recurrence, perioperative complications, and physician measure of esthetic outcomes (Whitaker score), were investigated. This technique was applied for contouring of the zygomatic-maxillary and calvarial bone for patients aged between 16 and 60 years (mean age: 26 y). The mean ± SD tumor volume reduction was 15.5 ± 8.95 cm 3 , and the postoperative mean ± SD tumor growth rate was 5.52 ± 6.26% per year. Satisfactory outcome was obtained in terms of esthetics with a mean ± SD Whitaker score of 1.41 ± 0.62. Patients required a mean operation time of 1.67 ± 0.43 hours and a mean number of shaving operations of 1.35 ± 0.61 during the follow-up period. Five of 17 patients required reoperation because of the tumor recurrence (N = 4) and to correct new-onset diplopia after surgery (N = 1). In conclusion, the multiple tangential shaving technique allows an easy approach for conservative management of craniofacial fibrous dysplasia. An acceptable rate of tumor recurrence and esthetic outcomes can be obtained by selecting the appropriate candidate for a conservative approach.

Section: Discussionmentioning

confidence: 99%

A Novel Bone Contouring Technique Using Multiple Tangential Shaving for Conservative Management of Craniofacial Fibrous Dysplasia

Kim

Park

Woo

et al. 2022

“…Intraoperative surgical guides are especially useful in the contouring of bones and adherence to safety margins. Surgical navigation technology offers intraoperative virtual display of both the operation area and the virtual plan by means of tracked instruments in real time, thus creating a “virtual-reality” bridge that allows the surgeon to verify the precision of the repair and transfer the previously determined preoperative virtual plan to the operating room 4,7. This, in turn, increases surgical safety and accuracy.…”

Section: Discussionmentioning

confidence: 99%

Craniofacial Fibrous Dysplasia of the Skull Assisted by Virtual Surgical Planning

Ainuz

Rizvi

Kane

2022

Craniofacial fibrous dysplasia (FD) involves thickening of the skull and facial bones, causing asymmetry and distortion of overlying soft tissues. Surgical contouring is often performed with rotary bur or osteotome, with the goal of matching contralateral unaffected anatomy. This is made technically challenging by having no direct visualization of contralateral structures, and the desire to control depth of resection to match the contour of the unaffected side. In our report, a 13-year-old male presented for surgical evaluation of craniofacial FD affecting the right parietal/temporal bones. A novel virtual surgical planning approach of premade drilling template with numerous pilot guide holes was used to assist bone debulking. The pilot holes allowed precise burring of the dysplastic bone. The patient achieved excellent calvarial contour symmetry without unintended intracranial extension. We believe that virtual surgical planning and drilling depth guides are effective tools in the reconstruction of craniofacial FD.

“…Recent methods for surgical navigation have greatly improved the accuracy of craniomaxillofacial bone surgeries, including bone fracture, temporomandibular joint arthroplasty, bone tumor resection, and contour trimming 3–6 . For craniomaxillofacial soft tissue, deformation may easily occur and can cause image drift during navigation procedures.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Recent methods for surgical navigation have greatly improved the accuracy of craniomaxillofacial bone surgeries, including bone fracture, temporomandibular joint arthroplasty, bone tumor resection, and contour trimming. [3][4][5][6] For craniomaxillofacial soft tissue, In recent years, real-time ultrasound image fusion techniques have improved and are currently widely available. These techniques offer several advantages, including the acquisition of real-time images without exposing patients to radiation.…”

Section: Discussionmentioning

confidence: 99%

Proposal for the Fusion of Ultrasound and Computed Tomography Images for Image Shift Correction in Craniomaxillofacial Soft Tissue Surgery

Yang

Zhang

et al. 2021

Surgical navigation has greatly improved the accuracy of craniomaxillofacial bone surgery and is widely used in the clinic. However, during surgery, craniomaxillofacial soft tissue is always deformed due to traction and compression, which leads to intraoperative image drift. This, in turn, impacts navigation accuracy. In order to improve navigation accuracy, this technical note presents a preliminary proposal for fusion imaging technology, which combines ultrasound and computed tomography to address navigational image drift in craniomaxillofacial soft tissue surgery.