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. 2015 Oct;73(10):2005-16.
doi: 10.1016/j.joms.2015.03.017. Epub 2015 Mar 19.

Assessment of the OsteoMark-Navigation System for Oral and Maxillofacial Surgery

Zachary S Peacock  1 , John C Magill  2 , Brad J Tricomi  3 , Brian A Murphy  4 , Vladimir Nikonovskiy  5 , Nobuhiko Hata  6 , Laurent Chauvin  7 , Maria J Troulis  8
Affiliations

Assessment of the OsteoMark-Navigation System for Oral and Maxillofacial Surgery

Zachary S Peacock et al. J Oral Maxillofac Surg. 2015 Oct.

Abstract

Purpose: To assess the accuracy of a novel navigation system for maxillofacial surgery using human cadavers and a live minipig model.

Materials and methods: We tested an electromagnetic tracking system (OsteoMark-Navigation) that uses simple sensors to determine the position and orientation of a hand-held pencil-like marking device. The device can translate 3-dimensional computed tomographic data intraoperatively to allow the surgeon to localize and draw a proposed osteotomy or the resection margins of a tumor on bone. The accuracy of the OsteoMark-Navigation system in locating and marking osteotomies and screw positions in human cadaver heads was assessed. In group 1 (n = 3, 6 sides), OsteoMark-Navigation marked osteotomies and screw positions were compared to virtual treatment plans. In group 2 (n = 3, 6 sides), marked osteotomies and screw positions for distraction osteogenesis devices were compared with those performed using fabricated guide stents. Three metrics were used to document the precision and accuracy. In group 3 (n = 1), the system was tested in a standard operating room environment.

Results: For group 1, the mean error between the points was 0.7 mm (horizontal) and 1.7 mm (vertical). Compared with the posterior and inferior mandibular border, the mean error was 1.2 and 1.7 mm, respectively. For group 2, the mean discrepancy between the points marked using the OsteoMark-Navigation system and the surgical guides was 1.9 mm (range 0 to 4.1). The system maintained accuracy on a live minipig in a standard operating room environment.

Conclusion: Based on this research OsteoMark-Navigation is a potentially powerful tool for clinical use in maxillofacial surgery. It has accuracy and precision comparable to that of existing clinical applications.

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Figures

Figure 1
Figure 1
A. The wheeled cart with two screens can be controlled by keyboard/mouse or touch screen, B. The OsteoMark-Navigation system pencil prototype was constructed from an electrocautery pen. Pencil tips are interchangeable. C. OsteoMark-Navigation demonstrated on a model mandible
Figure 1
Figure 1
A. The wheeled cart with two screens can be controlled by keyboard/mouse or touch screen, B. The OsteoMark-Navigation system pencil prototype was constructed from an electrocautery pen. Pencil tips are interchangeable. C. OsteoMark-Navigation demonstrated on a model mandible
Figure 1
Figure 1
A. The wheeled cart with two screens can be controlled by keyboard/mouse or touch screen, B. The OsteoMark-Navigation system pencil prototype was constructed from an electrocautery pen. Pencil tips are interchangeable. C. OsteoMark-Navigation demonstrated on a model mandible
Figure 2
Figure 2
A. Materialise ProPlan® services were used to an osteotomy and placement of a curvilinear distraction device and (B) produce a surgical guide.
Figure 2
Figure 2
A. Materialise ProPlan® services were used to an osteotomy and placement of a curvilinear distraction device and (B) produce a surgical guide.
Figure 3
Figure 3
Screw location ID and measurements to characterize locations. Measurements A and B determine Metric 1 and measurements C and D determine Metric 2.
Figure 4
Figure 4
A. Location of registration points and B-C, assessment of accuracy using transferred virtual plan of vertical ramus osteotomy and screw positions to cadaver mandible.
Figure 4
Figure 4
A. Location of registration points and B-C, assessment of accuracy using transferred virtual plan of vertical ramus osteotomy and screw positions to cadaver mandible.
Figure 4
Figure 4
A. Location of registration points and B-C, assessment of accuracy using transferred virtual plan of vertical ramus osteotomy and screw positions to cadaver mandible.
Figure 5
Figure 5
A. Histogram for Metric 1 error with most errors are within 1 mm (less than the size of holes in a plate). B. Histogram for Metric 2 errors from inferior and posterior border
Figure 5
Figure 5
A. Histogram for Metric 1 error with most errors are within 1 mm (less than the size of holes in a plate). B. Histogram for Metric 2 errors from inferior and posterior border
Figure 6
Figure 6
A comparison of position of osteotomy and screw holes with OsteoMark-Navigation (pencil marks) and that of the 3-D printed templates (blue ink) for right (A) and left (B) side. The right side shows precise but inaccurate markings compared to the surgical guide. C. Metric 3 histogram distances between screw hole locations as marked by OsteoMark-Navigation and templates
Figure 6
Figure 6
A comparison of position of osteotomy and screw holes with OsteoMark-Navigation (pencil marks) and that of the 3-D printed templates (blue ink) for right (A) and left (B) side. The right side shows precise but inaccurate markings compared to the surgical guide. C. Metric 3 histogram distances between screw hole locations as marked by OsteoMark-Navigation and templates
Figure 6
Figure 6
A comparison of position of osteotomy and screw holes with OsteoMark-Navigation (pencil marks) and that of the 3-D printed templates (blue ink) for right (A) and left (B) side. The right side shows precise but inaccurate markings compared to the surgical guide. C. Metric 3 histogram distances between screw hole locations as marked by OsteoMark-Navigation and templates
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