title: Implementation of a miniaturised navigation system in head and neck surgery for the detection and removal of foreign bodies.
abstract: The removal of embedded blast-generated fragments from soft tissue is very difficult, especially in the head and neck regions. First, because many retained foreign materials are non-metallic and can, therefore, not be detected by fluoroscopy, and second, because a broad exploration of the soft tissue is not possible in the facial area for functional and cosmetic reasons. Intraoperative navigation computer-assisted surgery (CAS) may facilitate the retrieval of foreign bodies and reduce exploration trauma. In a blind trial, five test specimens of different materials (glass, metal, wood, plastic, and stone) were inserted on the left and right sides of the head and neck of ten body donors through an intraoral incision. A second physician then detected and removed the foreign bodies from one side of the body without and from the other side of the body with navigation. We measured the duration of surgery, the extent of tissue trauma caused during surgery, the time it took to remove the foreign bodies, and the subjective evaluation of the usefulness of navigation. With the aid of the navigation system, the various foreign bodies were detected after an average of 26.7 (±35.1) s (p < 0.0001) and removed after an average of 79.1 (±66.2) s (p = 0.0239), with an average incision length of 10.0 (±3.5) mm. Without the navigation system, the foreign bodies were located after an average of 86.5 (±77.7) s and removed after an average of 74.1 (±45.9) s, with an average incision length of 13.0 mm (±3.6) mm (=0.0007). Intraoperative navigation systems are a valuable tool for removing foreign bodies from the soft tissue of the face and neck. Both the duration of surgery and the incision length can be reduced using navigation systems. Depending on the material of the foreign bodies and the signal intensity in the CT/MRI scanner, however, the detection reliability varies. All in all, navigation is considered to be a useful tool.
authors.affiliation: Department of Otorhinolaryngology, German Armed Forces Hospital, Ulm, Germany. kai.lorenz@extern.uni-ulm.de.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lorenz
authors.affiliation: Institute of Anatomy and Cell Biology, University Ulm, Ulm, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Böckers
authors.affiliation: Institute of Anatomy and Cell Biology, University Ulm, Ulm, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Fassnacht
authors.affiliation: Department of Maxillo-facial Surgery, German Armed Forces Hospital, Ulm, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Wilde
authors.affiliation: Department of Maxillo-facial Surgery, German Armed Forces Hospital, Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wegener
mesh_terms: D005471:Fluoroscopy; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery*; D006257:Head / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009333:Neck / Q000000981:diagnostic imaging / Q000601:surgery*; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Assisted surgery; CAS; Foreign body; Head and neck; Intraoperative navigation