Computer-Assisted Surgery in Craniomaxillofacial Surgery

Computer-assisted surgery is regarded as a surgical routine at the Center for Cranial Base/Craniofacial Surgery at the Medical University Freiburg. Between September 1997 and 2004, over 200 navigational guided procedures have been performed at the Department of Oral and Maxillofacial Surgery.

Our experiences with nasoethmoidal, orbital, midface, and skull reconstructions (primary and secondary) which were planned and operated using different navigation systems will be presented.

Using computer-assisted surgery the surgeon has a chance to virtually design the important reconstructive surgical steps prior to the operation. Reconstruction in minor-degree trauma with inconspicuous scars following surgical approaches using coronal and intraconjunctival incisions has developed to become procedures of choice. During surgery the planned contours can be well navigated. In unilateral deformities, mirroring of the unaffected side allows for the ideal virtual reconstruction. Meanwhile, the indications for using computer-assisted surgery on a routine basis are extended from primary and secondary midface and orbital corrections to optic nerve decompression, implant insertion, distraction, and skullbase tumors, in which the pretherapeutically defined safety margins (also, for example, following preoperative radio- or chemotherapy) are navigated during the operation. In addition, early experiences with navigation-guided endoscopic surgery are encouraging.