Initial Application Of Computer Assisted Navigation System In Unilateral Zygomatic Complex Fracture Reposition Treatment

Objective:The purpose of this study was to evaluate the value of computer assisted navigation system in unilateral zygomatic complex fracture reposition treatment,its advantages as well as its disadvantages,and to investigate the effectiveness of fracture reposition with Chromatographic analysis,precision and effect of fracture reposition operation,indications and limitations of application of computer assisted navigation system,and to summarize the technical process and the main points of clinical operation.Method:Five patients with unilateral zygomatic complex fracture due to trauma who needed operation were included in this study.Before operation,accurate maxillofacial CT scan were done regularly.DICOM data was transferred into workstation,and.computer assisted design was performed by using Surgicase CMF5.0 software and BrainLab Iplan CMF 3.0 software,including data segmentation,reconstructing three-dimensional skull models,mirroring,preoperative virtual surgery simulation.the virtual design was transferred to BrainLab navigation system,and intraoperative real-time navigation was made by computer assisted navigation system.Then BrainLab navigation system was used to guide and verify the reposition of the bone of zygomatic complex fracture.48 to 72 hours after operation,postoperative CT images and preoperative planning images were superimposed in Geomagic studio 12.0 software system and both were compared by three-dimensional(3D)objects,and Chromatographic analysis was performed to investigate the accuracy of the reposition operation of the affected side and navigation error.6 to 24 months after operation,the operation effect,indications and limitations of application of BrainLab navigation system were evaluated by means of review of facial symmetry,observation of complications,postoperative self-evaluation of satisfaction,and the technical process and the main points of clinical operation were summarized.Result:Preoperative planning design,surgery simulation were made successfully.Under the guidance of navigation,intraoperative real-time accurate navigation operations were performed,and the exact reposition of the bone of zygomatic complex fracture was guided and verified successfully.Chromatographic analysis showed global maximal deviation of the reposition of the bone of zygomatic complex fracture was less than 2 mm between the affected side and the mirror side of the healthy side,meanwhile,postoperative CT scan showed the reconstructed skull shape was basically in accordance with the preoperative design,and high accuracy was obtained.The patients were followed up 6-24 months(mean,12.8 months),good facial symmetry was obtained,and the associative function has been greatly improved,such as the mouth opening.No complication was observed in all patients.Postoperative self-evaluation of satisfaction was good,and the good effect of the operations was obtained.Conclusion:1.Computer assisted navigation system can achieve preoperative computer assisted surgical planning design and intraoperative real-time accurate navigation,can guide and verify the reposition of the bone of zygomatic complex fracture.Computer assisted navigation system also can instruct the treatment of unilateral zygomatic complex fractures effectively and acquire a high accuracy of the reposition operation.2.The global comparison with Chromatographic analysis is more objective for unilateral zygomatic complex fractures.3.Computer aided navigation system which is used for the treatment of unilateral zygomatic complex fractures,has a wide range of indications and some limitations.4.The navigation process includes two steps:preoperative design and intraoperative navigation.There are strict technical procedures and the main points of clinical operation,Standardizing the preoperative and intraoperative application of computer assisted navigation system can improve the accuracy and safety of the treatment of unilateral zygomatic complex fractures.5.Computer assisted navigation system can effectively increase the surgical precision in the treatment of unilateral zygomatic complex fractures and reduce complications,also can recover facial symmetry and associative function.It is regarded as a valuable technique in the reposition treatment of unilateral zygomatic complex fractures.