title: [CAS in rhino-surgical procedures in the growing age].
abstract: BACKGROUND
  Rhinosurgery in children and adolescents meets special requirements: Limited cooperation and reduced limits for the organ dose for ionizing radiological examinations aggravate diagnostics. On the other side, bone sutures and bone growth areas have to be respected intraoperatively, and regions of bones not yet calcified have to be distinguished from possible tumor infiltration. Computer assisted surgery (CAS) can help to identify these areas safely.
  
  
  METHODS
  5 patients, from the first to the 20 (th) year of life, suffering from tumors, malformation syndromes or therapy resistant nasal polyposis were treated with CAS in rhinosurgery.
  
  
  RESULTS
  In addition to radiological diagnostics, we performed 3D computed tomography of the skull for CAS. CAS enabled us to intraoperatively respect possible areas of bone growth, to identify regions with thin, not bonily developed cranial vault and to safely distinguish bone sutures from ethmoidal cells. CAS helped the surgeon to navigate in the not yet developed paranasal sinus system.
  
  
  CONCLUSIONS
  CAS is a useful complementary method in rhinosurgery of the developing skull of the child. In spite of the additional 3D computed tomography, the calculated organ dose of the ocular lense amounted to 5 millisievert, so a recommended maximal organ dose for the ocular lense of 15 millisievert was not exceeded.
authors.affiliation: Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg. schipper@hno.ukl.uni-freiburg.de
authors.forename: J
authors.initials: J
authors.lastname: Schipper
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.forename: N-C
authors.initials: NC
authors.lastname: Gellrich
authors.forename: I
authors.initials: I
authors.lastname: Arapakis
authors.forename: A
authors.initials: A
authors.lastname: Hochmuth
authors.forename: R
authors.initials: R
authors.lastname: Laszig
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002754:Choanal Atresia / Q000150:complications / Q000601:surgery; D003394:Craniofacial Dysostosis / Q000150:complications; D004314:Down Syndrome; D005260:Female; D005350:Fibroma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D009298:Nasal Polyps / Q000601:surgery; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D009305:Nasopharynx; D009666:Nose / Q000601:surgery*; D009668:Nose Diseases / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery; D012886:Skull / Q000000981:diagnostic imaging; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D014057:Tomography, X-Ray Computed