Increased accuracy of Bonebridge placement using Otoplan and navigation

Background The second generation of the bonebridge (BB) is widely used even in younger children. Preoperative imaging often reveals only small areas in which the FMT (4.5mm) or screws (2.5mm) can be fully and safely inserted. The use of navigation systems can enable precise placement of the device and prevent potential complications such as dural or vascular injuries. The most recent release of the preoperative planning software Otoplan enables the user to not only assess the bone thickness, but also to virtually implant the patient and export models of the implanted BB.

Materials & Methods Six children were implanted with a BB using Otoplan with export of the desired position of the BB into the navigation system. Patients received 3 marker screws in the temporal bone prior to an intraoperative cone beam CT (CBCT) scan. Images were loaded into Otoplan to virtually define the optimal BB position and to export the corresponding model. Both the CBCT scan and the model were then loaded into an electromagnetic navigation system. The screws were used for exact registration of the system and the planned BB placement was projected onto the actual patient. BB implantation was then pursued accordingly and finally, the marker screws were explanted.

Results Bone thickness at the position of the screws was in each case over 2.5mm, so that the accuracy of this procedure could be documented and none of the screws could injure the dura.

Conclusion The virtual implantation using otoplan can be loaded into a navigation system and the targeted, safe position of the screws can then be easily marked on the temporal bone. The projection of the planned position onto the patient using navigation is a practical tool that can make the implantation more reliable and safer for the patients.

 

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Publication History

Article published online:
19 April 2024