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. 2021 Feb 25;11(1):4657.
doi: 10.1038/s41598-021-84129-5.

Electromagnetic surgical navigation in patients undergoing mandibular surgery

S G Brouwer de Koning  1 , F Geldof  2 , R L P van Veen  3   4 , M J A van Alphen  3   4 , L H E Karssemakers  3   4 , J Nijkamp  2 , W H Schreuder  3   4 , T J M Ruers  2   5 , M B Karakullukcu  3   4
Affiliations

Electromagnetic surgical navigation in patients undergoing mandibular surgery

S G Brouwer de Koning et al. Sci Rep. .

Abstract

The purpose of this study was to evaluate the feasibility of electromagnetic (EM) navigation for guidance on osteotomies in patients undergoing oncologic mandibular surgery. Preoperatively, a 3D rendered model of the mandible was constructed from diagnostic computed tomography (CT) images. Cutting guides and patient specific reconstruction plates were designed and printed for intraoperative use. Intraoperative patient registration was performed using a cone beam CT scan (CBCT). The location of the mandible was tracked with an EM sensor fixated to the mandible. The real-time location of both the mandible and a pointer were displayed on the navigation system. Accuracy measurements were performed by pinpointing four anatomical landmarks and four landmarks on the cutting guide using the pointer on the patient and comparing these locations to the corresponding locations on the CBCT. Differences between actual and virtual locations were expressed as target registration error (TRE). The procedure was performed in eleven patients. TREs were 3.2 ± 1.1 mm and 2.6 ± 1.5 mm using anatomical landmarks and landmarks on the cutting guide, respectively. The navigation procedure added on average half an hour to the duration of the surgery. This is the first study that reports on the accuracy of EM navigation in patients undergoing mandibular surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Overview of pre-, intra- and post-operative steps of the surgical navigation procedure.
Figure 2
Figure 2
(a) EM sensor placed in a sensor housing module that was designed for this study. (b) The sensor housing module with EM sensor fixated to the mandible with screws.
Figure 3
Figure 3
Schematic model of a mandible with the cutting guide (green). The sensor housing module (black) is fixated on the part of the mandible that will be resected. The yellow landmarks are used for fiducial registration. The anatomical landmarks (red) are located on teeth and mental foramen. The landmarks at the cutting guide (blue) are located in the upper and lower ends of the sawing slots. Dental numbering according to the FDI World Dental Federation (ISO 3950).
Figure 4
Figure 4
The surgeon points at the resection plane with the tracked pointer (a). The position of the pointer in relation to the mandible (white), the cutting guide (green), and the resection planes (blue) are shown in the sagittal and axial sections (b,c) and the 3D model (d).
Figure 5
Figure 5
Surgical delay due to navigation workflow.
See this image and copyright information in PMC

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