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JOMS study: Surgical navigation shows promise as an innovative tool for oral and facial surgery

ROSEMONT, Ill. – Surgical navigation is a “very promising” tool for oral and maxillofacial surgeons, although its high cost and steep learning curve are possible drawbacks, according to a new study.

Surgical navigation – when doctors use a system to track their instruments during computer-assisted surgery – is similar to GPS in cars. Through surgical navigation’s three chief components – a localizer similar to a satellite, a surgical probe and a computed tomography scan dataset similar to a map – data are inputted into a computer and used to guide surgical procedures.

Surgical navigation can be useful for surgical planning, execution, evaluation and research, according to the systematic review published in the September issue of the Journal of Oral and Maxillofacial Surgery, the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS). 

To examine surgical navigation’s most common indications, treatments and outcomes, researchers conducted a search in electronic databases, journals and bibliographies published between 2010 and 2015 that included clinical studies of at least five patients. The areas of interest were traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery and foreign body removal.

Using surgical navigation “considerably improved” treatment of complex orbital fractures in comparison to traditionally treated control groups, researchers concluded. Surgical navigation also is “an excellent device for treatment evaluation” and could have a role in research “in the search of clinical excellence.” 

Another advantage of surgical navigation in orthognathic (corrective jaw) surgery lets the operator relate segment movements to the simulated plan for cutting of bone, which is otherwise impossible with traditional-model surgical procedures that carry a higher risk of inaccuracy.

Planning a procedure in a three-dimensional environment and executing it with “real-time guidance” can greatly improve precision, researchers concluded. All surgical team members have to be highly integrated in the process, researchers added. 

Surgical navigation techniques have been tried in maxillofacial surgery, but “some major challenges” have occurred, according to the study. 

When considering integrating surgical navigation as part of the treatment regimen, “one must bear in mind that great surgical skills cannot be compromised,” researchers said. “There is a learning curve and financial concerns to be dealt with, but oral and maxillofacial surgeons report that [it] is a very beneficial tool when the techniques have been sufficiently mastered.” 

The authors of “Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery” are R. Bryan Bell, MD, DDS, Director, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland, Ore.; and Iman Azarmehr, DDS, Kasper Stokbro, DDS, and Torben Thygesen, DDS, PhD, all from the Department of Oral and Maxillofacial Surgery, Odense University Hospital, Denmark.

The full article can be accessed at www.joms.org/article/S0278-2391(17)30073-3/fulltext.