Computer-navigated surgery may be essential for successful reconstruction of complex facial fractures.
The reconstruction of complex three-dimensional structures such as the orbital cavity remains one of the major challenges in facial surgery. Fractures of the cheekbone (zygomatic bone), which forms the inferior and lateral margin of the orbit, account for about 40% of injuries in the facial skull region caused by trauma or accidents. This means that zygomatic bone fractures are the second most common type of fracture in the facial region.
Fractures affecting the orbit may not be noticed immediately by the patient. This is because the swelling can camouflage problems of a changed orbital geometry by keeping the eye in the correct position for some days. Only when the swelling subsides the effects of the facial fracture involving the eye socket become evident and the sensory perception changes so that double vision or restricted motility of the eye may be noticed.
The difficulty of reconstruction of the orbit increases with the number of fracture fragments. In the case of comminuted fractures, for example, with loss of anatomical landmarks, successful anatomical reconstruction is almost impossible without the use of state-of-the-art technology. One of the technological solutions developed for this purpose is computer-navigated surgery. In fact, this technique enables correct anatomical reconstruction even in case of complete comminution of bones. The information required for symmetrical reconstruction is gathered from the healthy side and mirrored to the injured side. By doing so the injured side can be reconstructed with meticulous attention to detail.
Despite the more complex pre-operative preparations involved, the use of this modern technique enables us to ensure accurate three-dimensional reconstruction of the orbital cavity with maximum precision and attention to detail. The necessity of corrective surgery, which causes additional stress for patients and is often more complicated due to previous scarring, can thus be eliminated.
Navigated surgery is also highly instrumental in the correction of fractures that have healed in a dislocated position. Slice imaging modalities (computed tomography, magnetic resonance imaging) help to identify the extent of the injury to enable patient-specific pre-operative detail planning and simulation of the eye socket reconstruction. As a result, it is possible to design an individual implant for corrective surgery, which may replace the broken floor or even several walls of the orbit.
Intraoperative position control by means of computer-assisted navigation is generally performed through a minimally invasive incision in a non-visible area. With this procedure, the risk of additional soft tissue damage is significantly reduced.
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