Invited Review Paper
Emerging Technologies
Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review

https://doi.org/10.1016/j.ijom.2004.03.018Get rights and content

Abstract

Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies.

The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application.

One hundred and fifty-eight operations with successful application of surgical navigation technology—divided into five groups—are evaluated regarding the criteria “medical benefit” and “technical expenditure” necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation.

Section snippets

Imaging systems

The basic principle for application of augmented reality and computer-aided navigation in craniomaxillofacial surgery is the visualization of two- and three-dimensional views of the surgical site superposed on the real image of interest. In most cases computertomographic images are used (CT), but conventional X-rays, magnetic resonance imaging (MRI) or fusion of CT and MRT images are also available for special indications.

The two- and three-dimensional images of the real anatomical situation

Results

Group I (positioning of dental implants) included 72 patients (395 implants), group II (arthroscopies of the temporomandibular joint and intraoperative optoelectronic axiographies) 26 patients, group III (osteotomies and distractions) 33 patients, group IV (removal of foreign bodies, image guided biopsies, punctures of the trigeminal ganglion) 19 patients and group V (other procedures) 8 patients. A chronological synopsis is given in Table 1 and Fig. 7, Fig. 8.

Groups I–IV (after thorough

Discussion

Basic research and routine clinical application of computer-aided navigation technology conducted over the past 10 years have proved that the application of this technology offers essential improvement in outcome and intraoperative safety in a wide range of craniomaxillofacial procedures. The 158 procedures discussed in this paper were performed with varying system-configurations within the groups due to ongoing technological progress. Each developmental step was tested before clinical

Acknowledgements

This work was financially supported by the Austrian Science Foundation FWF (Grant P-12489 Med).

References (36)

  • A. Wagner et al.

    A comparative analysis of optical and conventional axiography for the analysis of temporomandibular joint movements

    J. Prosthet. Dent

    (2003)
  • A. Wagner et al.

    Interactive stereotaxic teleassistance of remote experts during arthroscopic procedures

    Arthroscopy

    (2002)
  • A. Wagner et al.

    Principles of computer-assisted arthroscopy of the temporomandibular joint with optoelectronic tracking technology

    Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod

    (2001)
  • F. Watzinger et al.

    Positioning of dental implants using computer-aided navigation and an optical tracking system: case report and presentation of a new method

    J. Craniomaxillofac. Surg

    (1999)
  • F. Watzinger et al.

    Computer-aided surgery in distraction osteogenesis of the maxilla and mandible

    Int. J. Oral Maxillofac. Surg

    (1999)
  • F. Watzinger et al.

    Computer-aided navigation in secondary reconstruction of post-traumatic deformities of the zygote

    J. Craniomaxillofac. Surg

    (1997)
  • W. Birkfellner et al.

    A head-mounted operating binocular for augmented reality visualization in medicine—design and initial evaluation

    IEEE Trans. Med. Imaging

    (2002)
  • W. Birkfellner et al.

    A modular software system for computer-aided surgery and its first application in oral implantology

    IEEE Trans. Med. Imaging

    (2000)
  • Cited by (223)

    • Science mapping analysis of maxillofacial reconstruction over the last four decades

      2024, Journal of Stomatology, Oral and Maxillofacial Surgery
    • Training arthrocentesis and arthroscopy: Using surgical navigation to bend the learning curve

      2023, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
    • Accuracy and application range of a splint integrated with a reference array and registration fiducial markers for mandibular navigation surgery in artificial skulls

      2022, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
      Citation Excerpt :

      Navigation surgery plays an important role in craniomaxillofacial surgery and has been used in many different types of procedures, such as facial deformity correction, temporomandibular joint arthroplasty, removal of foreign bodies, dental implantation, and tumor resection [1–11].

    • Navigation in surgical arthroscopy of the temporomandibular joint

      2022, British Journal of Oral and Maxillofacial Surgery
    • Referencing for intraoperative navigation: Evaluation of human bias

      2022, Journal of Stomatology, Oral and Maxillofacial Surgery
    View all citing articles on Scopus
    View full text