title: Analysis of carotid artery deformation in different head and neck positions for maxillofacial catheter navigation in advanced oral cancer treatment.
abstract: BACKGROUND
  To improve the accuracy of catheter navigation, it is important to develop a method to predict shifts of carotid artery (CA) bifurcations caused by intraoperative deformation. An important factor affecting the accuracy of electromagnetic maxillofacial catheter navigation systems is CA deformations. We aimed to assess CA deformation in different head and neck positions.
  
  
  METHODS
  Using two sets of computed tomography angiography (CTA) images of six patients, displacements of the skull (maxillofacial segments), C1-C4 cervical vertebrae, mandible (mandibular segment), and CA along with its branches were analyzed. Segmented rigid bones around CA were considered the main causes of CA deformation. After superimposition of maxillofacial segments, C1-C4 and mandible segments were superimposed separately for displacement measurements. Five bifurcation points (vA-vE) were assessed after extracting the CA centerline. A new standardized coordinate system, regardless of patient-specific scanning positions, was employed. It was created using the principal axes of inertia of the maxillofacial bone segments of patients. Position and orientation parameters were transferred to this coordinate system. CA deformation in different head and neck positions was assessed.
  
  
  RESULTS
  Absolute shifts in the center of gravity in the bone models for different segments were C1, 1.02 ± 0.9; C2, 2.18 ± 1.81; C3, 4.25 ± 3.85; C4, 5.90 ± 5.14; and mandible, 1.75 ± 2.76 mm. Shifts of CA bifurcations were vA, 5.52 ± 4.12; vB, 4.02 ± 3.27; vC, 4.39 ± 2.42; vD, 4.48 ± 1.88; and vE, 2.47 ± 1.32. Displacements, position changes, and orientation changes of C1-C4 segments as well as the displacements of all CA bifurcation points were similar in individual patients.
  
  
  CONCLUSIONS
  CA deformation was objectively proven as an important factor contributing to errors in maxillofacial navigation. Our study results suggest that small movements of the bones around CA can result in small CA deformations. Although patients' faces were not fixed properly during CT scanning, C1-C4 and vA-vE displacements were similar in individual patients. We proposed a novel method for accumulation of the displacement data, and this study indicated the importance of surrounding bone displacements in predicting CA bifurcation.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. t096008d@yokohama-cu.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohya
authors.forename: Toshinori
authors.initials: T
authors.lastname: Iwai
authors.forename: Kuan
authors.initials: K
authors.lastname: Luan
authors.forename: Takashi
authors.initials: T
authors.lastname: Kato
authors.forename: Hongen
authors.initials: H
authors.lastname: Liao
authors.forename: Etsuko
authors.initials: E
authors.lastname: Kobayashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kohno
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sakuma
authors.forename: Iwai
authors.initials: I
authors.lastname: Tohnai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016477:Artifacts; D002339:Carotid Arteries / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D057785:Catheters; D005260:Female; D006257:Head / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009062:Mouth Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D009333:Neck / Q000098:blood supply*; D019647:Oral Surgical Procedures / Q000379:methods*