Technical note: "look-ahead" navigation method for K-wire fixation in rhinoplasty.
OBJECTIVE
The Kirschner wire (K-wire) technique for fixation of rib cartilage grafts to the maxilla is a powerful tool in rhinoplasty. It gives the nose unparalleled anterior projection. However, the technique is challenging because of poor maxillary visualization through the open rhinoplasty approach. Inaccurate K-wire placement can cause dental injury or violation of the nasal/palatal mucosa. This study evaluates the efficacy of a surgical navigation system to guide K-wire placement.


METHODS
K-wires were placed, through an open rhinoplasty approach, into the maxilla of 12 fresh cadaver heads by a single surgeon. Six control specimens had K-wires placed without navigation. Six treatment specimens had K-wires placed with the "look-ahead navigation method," in which a surgical navigation device was attached to the K-wire gun. All maxillae were then sectioned to determine the final location of the K-wires.


RESULTS
Four out of five (80%) of the K-wires were successfully placed in the treatment group, although only 3 out of 6 (50%) of the K-wires were successfully placed in the control group. One treatment K-wire was dislodged during the sectioning process and had to be excluded. The average K-wire deviation in the axial plane was less for the treatment group (0.2 +/- 0.4 mm) than for the control group (1.8 +/- 1.5 mm; P < .05).


CONCLUSIONS
When surgical navigation is used in K-wired cartilage strut graft placement to maxilla, it can improve the accuracy of K-wire placement. This may result in reduced complications due to errant K-wire placement.
Kim
Kenneth K
KK
Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, Illinois, USA.
Zhao
Linping
L
Belafsky
Peter
P
Patel
Pravin K
PK
Strong
E Bradley
EB
D001864:Bone Wires; D002102:Cadaver; D002356:Cartilage / Q000637:transplantation*; D006801:Humans; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D009295:Nasal Bone / Q000000981:diagnostic imaging; D012225:Rhinoplasty / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed