Image-guided endoscopic navigation for the precise resection of a mandibular condylar osteochondroma.
OBJECTIVE
The authors describe an intraoral approach to accessing the mandibular condyle using endoscopy combined with a navigation system and explore the feasibility of this technique for the precise excision of a benign tumor in the condyle.


METHODS
The junction between the osteochondroma and the condyle was recognized and defined as the osteotomy line in a CT-based surgery planning software, and the surgical plan was then exported to a navigation system. A 4-mm-diameter 30-degree endoscope was placed in the wound with direct access to the entire condyle. Based on constant feedback from the navigation system in multiplanar and 3D views, the landmarks of the osteotomy line were identified, and precise tumor resection was achieved.


RESULTS
The magnified endoscopic view allowed the condylar head and neck to be easily dissected with good illumination and clear visualization. The landmarks of the osteotomy line were transferred from the virtual surgical plan to the surgical field, and precise resection of the condylar tumor was achieved.


CONCLUSIONS
The combined technique reported in this paper could represent a valid minimally invasive approach to the ramus-condyle unit for direct visualization of the medial aspect of the condyle and precise resection of benign tumor located here.
From the Shanghai Key Laboratory of Stomatology, Shanghai, and Department of Oral and Craniomaxillofacial Science, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Hao
H
Sun
Biao
B
Li
Shunyao
S
Shen
Tong
T
Yang
Lei
L
Zhang
Steve G F
SG
Shen
Xudong
X
Wang
D000328:Adult; D004210:Dissection / Q000295:instrumentation / Q000379:methods; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008335:Mandibular Condyle / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D015831:Osteochondroma / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010347:Patient Care Planning; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014584:User-Computer Interface