title: Image-guided navigation in optimizing surgical management of craniomaxillofacial fibrous dysplasia.
abstract: BACKGROUND
  Fibrous dysplasia is a benign developmental dysplastic disorder of the bone in which abnormal fibroblastic proliferation replaces the normal bone matrix. Craniomaxillofacial fibrous dysplasia can cause severe deformity with devastating functional and aesthetic consequence. Precise surgical removal of the fibro-osseous tissue is the key to ultimately restore normal function and aesthetics. Navigational surgical tool has become a useful adjunct in the surgical management of the craniomaxillofacial skeleton.
  
  
  METHODS
  Thirteen patients with facial asymmetry and deformity caused by craniomaxillofacial fibrous dysplasia were enrolled into this study. With preoperative planning and three-dimensional simulation, normal anatomic contours of the deformed area were recreated by superimposing unaffected to the affected side. After registration, surgical facial recontouring was performed under the guidance of navigation system.
  
  
  RESULTS
  Good accuracy was achieved with the registration of patient's facial skeleton and preoperative three-dimensional reconstructed model in all the cases. With intraoperative navigational guidance, facial bone recontouring was performed uneventfully in all cases. Surgical accuracy was evaluated by comparing the preoperative and postoperative computed tomography scan measurement. The mean maximum discrepancy between the actual surgical reduction and preoperative planning was less than 2 mm. Symptoms associated with optical nerve compression were eliminated in affected individuals. All patients' facial symmetry and aesthetics were improved.
  
  
  CONCLUSIONS
  Navigation-guided facial bone recontouring is a valuable treatment modality in managing craniomaxillofacial fibrous dysplasia.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University, 639, Zhizaoju Rd, Shanghai, People’s Republic of China 200011.
authors.forename: Xudong
authors.initials: X
authors.lastname: Wang
authors.forename: Yanping
authors.initials: Y
authors.lastname: Lin
authors.forename: Hongbo
authors.initials: H
authors.lastname: Yu
authors.forename: Andrew Hua-An
authors.initials: AH
authors.lastname: Cheng
authors.forename: Hao
authors.initials: H
authors.lastname: Sun
authors.forename: Chengtao
authors.initials: C
authors.lastname: Wang
authors.forename: Guofang
authors.initials: G
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D019465:Craniofacial Abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D005146:Facial Asymmetry / Q000000981:diagnostic imaging / Q000601:surgery*; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome