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Review
. 2019 Jul;67(7):995-1003.
doi: 10.4103/ijo.IJO_807_18.

Computer-assisted navigation in orbitofacial surgery

Priti Udhay  1 , Kasturi Bhattacharjee  2 , P Ananthnarayanan  3 , Gangadhar Sundar  4
Affiliations
Review

Computer-assisted navigation in orbitofacial surgery

Priti Udhay et al. Indian J Ophthalmol. 2019 Jul.

Abstract

The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.

Keywords: Computer-assisted orbital surgery; image-guided orbital surgery; navigation surgery; navigation-guided optic canal decompression; navigation-guided orbital decompression; posttraumatic orbital reconstruction.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Stereolithographic model, (b) osteotomy planned on the model, (c) bone fragment marked and removed, (d) implant precontoured on the model. The models in a, b, and c and d belong to three different patients
Figure 2
Figure 2
Flow chart
Figure 3
Figure 3
Analogy of the navigation system with Global Positioning System
Figure 4
Figure 4
(a) Left normal orbit mirrored onto right affected orbit (orange outline) using mirroring software. (b) Lesion localizer software used to outline orbitocavernous tumor
Figure 5
Figure 5
(A) (a and b) Clinical picture showing enophthalmos right eye and loss of malar eminence. (c and d) CT scans showing inadequately reduced zygoma and orbital floor and medial wall fractures (surgery by another surgeon). (e and f) Intraoperative pictures after reduction and fixation showing the implants used. (B) (g and h) Navigation pointer placed on the zygoma and orbital implant showing proper reduction and implant position corresponding with the mirrored image. (C) (i-n) Postop CT scans and clinical picture showing the implant position and symmetry with opposite side and significant improvement in enophthalmos and malar prominence
Figure 6
Figure 6
(A) (a-c) Clinical picture showing right enophthalmos. Patient had a ptosis correction and intraocular surgery done elsewhere. (d) CT scan showing right medial wall fracture. (e and f) CTDCG showing intact lacrimal drainage system (red arrows). (B) (g) Navigation pointer used to assess the extent of the fracture. (h) Pointer placed over the implant shows correct placement of implant coinciding with the mirrored image (blue). (C) (i-n) Postop CT scan and clinical picture showing the implant position and improvement in enophthalmos
Figure 7
Figure 7
(a) Child with neurofibroma orbit. (b) Tumor localizer software used to outline the tumor and color coding used to mark the vessels
Figure 8
Figure 8
(A) (a) Navigation pointer used to locate the target area, i.e. the medial wall of the optic canal. (b) Intraop picture showing the fractured bony fragment impinging the optic nerve. The navigation screen used for endoscopic guidance. (B) Exposed optic nerve after decompression of the canal
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References

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