Temporary intermaxillary fixation using individualized acrylic splints permits image-data-based surgery of the lower jaw and oropharynx.
OBJECTIVE
Image-data-based surgical navigation is used as a helpful device in the operating room to localize critical structures with a high degree of accuracy. It also enables physicians to plan therapeutic performance. Because it relies on preoperatively acquired computed tomography (CT) or magnetic resonance imaging (MRI) data, there is restricted access for navigation of surgical instruments in areas that show motion uncorrelated with radiologic data. Thus, in the case of moveable structures, for example the lower jaw, navigational procedures could not yet be applied.


METHODS
We introduce a new technique using individualized intermaxillary splints that fix the mandible in a reproducible aboccluded position at the time of image-data acquisition and surgery.


METHODS
Different manufacturing processes were investigated. The feasibility of uni- and bilateral intermaxillary splints was studied under clinical conditions in four patients during different procedures in the mandibular and oropharyngeal regions.


RESULTS
The manufacturing of the splints showed was easily performed in a short time. With bilateral fixation, there was a high anatomic target precision of 1.6 to 2.3 mm.


CONCLUSIONS
The use of bilateral intermaxillary splints that fix the patient's mandible in a reproducible aboccluded position permits an image-data-based navigated surgical approach to the oropharyngeal and mandibular regions.
Department of Oral and Maxillofacial Plastic Surgery, Tübingen University Hospital, Tübingen, Germany. juergen.hoffmann@uni-tuebingen.de
Jürgen
J
Hoffmann
Dirk
D
Troitzsch
Carsten
C
Westendorff
Octavio
O
Weinhold
Siegmar
S
Reinert
D006801:Humans; D021621:Imaging, Three-Dimensional; D008334:Mandible / Q000601:surgery*; D008437:Maxilla; D009960:Oropharynx / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D019904:Polymethyl Methacrylate; D012371:Robotics; D013165:Splints; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
D019904:Polymethyl Methacrylate