口腔颌面数字化外科的应用与展望

数字化外科作为现代影像技术、立体定向技术、电子计算机技术和人工智能技术与医学相结合的产物,近年来在国内外得到了迅速的发展和应用。本文主要从个体化数字设计、快速成型技术以及手术导航系统等方面在口腔颌面外科中的应用、发展情况以及前景等方面作一评述。     

动态实时导航在口腔种植领域中的临床应用及新进展

动态实时导航系统引导下的口腔种植手术是计算机辅助种植外科的一种。医生可以在术前通过导航系统的内部软件合理规划理想的植体位置,并在导航系统的引导下将术前设计准确转移到术中,术中医生可以实时观察到手机钻针在术区牙槽骨内的位置并及时作出调整。目前导航系统在临床的应用越来越广泛,尤其是在前牙美学区病例和在术区解剖条件较为复杂的牙列缺损病例中使用较多。但是动态实时导航系统的临床使用流程较为复杂,包括佩戴配准装置拍摄CBCT、以修复为导向的种植体三维位置设计、术中标定、术中配准、在导航引导下进行扩孔和种植体植入等。应用时需考量的因素和细节较多,包括种植体位置设计、追踪装置的坚固固定、配准误差、按照导航引导的稳定扩孔等。本文从种植手术导航系统的临床应用与工作流程、临床应用的效果及特点等方面进行述评,并介绍动态实时导航系统在口腔种植领域的应用新进展,包括无牙颌种植导航手术和导航引导下的穿颧种植手术。进一步提高种植手术导航的精度、简化使用流程将会是未来导航系统的发展方向。     

基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究

目的 搭建基于混合现实（MR）及红外光学定位的手术导航系统,并评估其在颅颌面创伤骨整复中的临床适用性。 方法 集成基于MR技术和光学定位追踪的软硬件系统,并完善系统工作流程;通过3D打印头颅模型实验,分析该系统的系统误差、目标配准误差和截骨应用误差;进一步通过颧上颌骨复合体（ZMC）复位的模型实验和额骨缺损修复的初步临床应用,探讨该系统的适用性。 结果 本MR手术导航系统的系统误差为（1.23±0.52）mm,目标配准误差为（2.83±1.18）mm,截骨应用误差为（3.13±1.66）mm;ZMC模型虚拟手术规划流畅,复位顺利;本系统引导下的额骨缺损修复重建手术过程顺利,重建效果满意。 结论 本研究搭建的MR手术导航系统具有虚实融合效果佳、动态导航稳定性好的优点,其在颅颌面外科的医患沟通、医学教育、术前规划和术中导航等各方面都具有应用潜力。     

光学导航技术在口腔颌面深部间隙异物取出术中的应用

目的:探讨光学导航技术应用于口腔颌面深部异物留置取出术的适应条件和临床价值。方法:对5例口腔颌面部外伤后异物留置于深部间隙的患者在导航辅助下行异物取出术,术前进行三维CT和数字减影血管造影检查,对异物进行空间定位,并将CT的Dicom数据导入STN导航系统中,用于术前手术规划和术中导航。术中观察导航系统的实时性和精确性,评价导航技术对口腔颌面部深部间隙异物取出的有效性。结果:在光学导航技术辅助下,5例留置的异物均能通过微创入路顺利定位和取出,术中未发现神经、血管损伤,术后亦未发现感染、呼吸困难等并发症。术后随访3～12个月,患者主诉症状均缓解,功能和面型取得了满意的效果。结论:光学导航技术在口腔颌面深部间隙异物取出术中的应用,尤其在解剖位置复杂和危险的区域,可以提高手术的精确性、微创性和安全性。     

计算机导航技术在口腔颌面部创伤整复中的应用

目的 探讨数字化外科技术在创伤后继发畸形治疗中的作用,总结技术流程及临床操作常规.方法 将2011年5月至2012年2月北京大学口腔医学院·口腔医院口腔颌面外科收治患者共54例纳入本研究,其中男性37例,女性17例,平均年龄32.4岁.术前三维CT扫描数据,应用BrainLab Iplan或Surgicase CMF 5.0软件进行数据分割、三维重建、术前虚拟规划,术中采用BrainLab Navigation系统引导手术操作.术后48 ～72 h复查头颅CT,术前、术后CT在BrainLab Iplan系统中进行自动数据融合,采用二维测量和三维色谱分析法评估真实外科手术与虚拟设计的吻合度.结果 54例手术均无明显并发症;所有患者均对手术效果满意.导航系统精度在颧骨颧弓骨折复位手术为0.2～3.5 mm、单纯眶壁缺损重建手术为0.8～2.0 mm、个性化假体植入手术为0.2 ～2.2 mm.结论 计算机虚拟规划有利于提高术前规划的精确性、可控性;导航系统能够作为信息载体,将虚拟计划信息传达到外科手术中,保证后者按照设计精确执行.     

动态导航系统在口腔种植中的临床应用及展望

 动态导航系统可有效提高种植手术的精度，辅助实现以修复为导向的种植体植入，获得更加稳定的种植修复效果。根据定位光源的种类及位置，动态导航系统有不同的分类，其工作流程包括数据获取、数据处理和种植方案设计、标定和配准、手术实施及术后精度验证。动态导航系统的精度与静态导板系统相近，且其可有效弥补静态导板系统在临床应用中的诸多不足，适应证更广，对于在无牙颌种植、穿颧种植等复杂种植手术中的应用还具有独特的优势。而提高精度、简化装置及操作流程、提高导航软件的修复模块功能、加强在临床教学中的应用及降低价格等方面将是动态导航系统未来发展的主要方向。文章就动态导航系统在口腔种植中的临床应用及展望做一阐述。     

动态导航系统在口腔种植中的临床应用及展望

动态导航系统可有效提高种植手术的精度，辅助实现以修复为导向的种植体植入，获得更加稳定的种植修复效果。根据定位光源的种类及位置，动态导航系统有不同的分类，其工作流程包括数据获取、数据处理和种植方案设计、标定和配准、手术实施及术后精度验证。动态导航系统的精度与静态导板系统相近，且其可有效弥补静态导板系统在临床应用中的诸多不足，适应证更广，对于在无牙颌种植、穿颧种植等复杂种植手术中的应用还具有独特的优势。而提高精度、简化装置及操作流程、提高导航软件的修复模块功能、加强在临床教学中的应用及降低价格等方面将是动态导航系统未来发展的主要方向。文章就动态导航系统在口腔种植中的临床应用及展望做一阐述。     

光学导航定位多自由度机械臂辅助颅颌面骨畸形整复技术方法的建立及初步应用

目的:基于现有的光学定位正颌外科导航手术的技术路线,建立并验证光学导航定位下机械臂辅助颅颌面骨畸形整复手术的技术路线.方法:(1)应用工业机械臂Motoman作为执行机构,并与现有导航系统实现整合;(2)按照术前规划,在导航下对颅骨模型进行截骨操作;(3)记录实验相关数据并进行误差分析.结果:自主算法实现了机械臂与导航...     

手术导航系统在颅颌面外科的应用

总结术中导航技术的发展历史、基本组成、工作原理和精度影响因素，重点讨论了近年来术中导航技术在颅颌面外科的应用现状，包括神经外科、口腔颌面外科、耳鼻咽喉科、放疗科等。结果显示术中导航将使手术更加个性化，精度更高，更加微创，因而有着良好的应用前景。     

基于快速原型技术的导航辅助下颌骨内置式牵张成骨术的实验研究

目的：应用自主研发的导航手术系统,在快速原型技术制作的三维头颅模型上进行内置式下颌骨牵张成骨术的实验研究,通过三维定点测量,分析该导航手术的精度。方法：对1例单侧下颌骨发育不足的患者行螺旋CT扫描后,采用快速原型技术制作5个相同的头模,按导航配准原则植入定位钉后再行CT扫描。应用AccuNavi 1.0软件对三维图像进行测量,并与游标卡尺实体测量的相应指标进行头模制作精度检测。然后进行下颌骨三维测量分析与虚拟单侧内置式下颌支牵张成骨术,将制定的手术规划通过实时TBNavis-CMFS导航系统在三维头模上实施,牵引到位后,行CT扫描图像重建,应用AccuNavi1.0软件与Surgicase5.0软件进行三维测量与牵引长轴间成角测量,采用SPSS13.0软件包对结果进行配对t检验。结果：快速原型制作的三维头模与AccuNavi1.0软件重建的三维图像间各测量指标无统计学差异（P〉0.05）。模型手术平均牵引长度12.40mm（11.79～12.68mm）,模拟手术与导航模型术后牵引长轴间成角均值为4.67°（2.01°～6.49°）。导航术后各项指标中,除CoL-CoR（P=0.037）、CoL-GoL（P=0.017）与模拟手术值间有显著性差异外,其余指标间均无显著性差异（P〉0.05）。结论：应用快速原型技术制作的三维头颅模型与AccuNavi1.0软件的三维重建图像精度相仿。通过TBNavis-CMFS导航系统平台,建立了导航辅助下颌骨牵引成骨术的实验方法,准确地将手术规划转移到模型手术中。     

高精度光学导航辅助颅颌面骨畸形整复的技术方法建立与应用

目的：通过自主建立用于颅颌面手术的高精度计算机导航软硬件系统,模拟和精确设计手术方案,实现术中实时可视化手术导航。方法：（1）创建颅颌面整复手术规划及导航软件（TBNAVIS—CMFS）。（2）建立基于Polaris光学定位仪的导航工作站。（3）临床上对50例复杂颅颌面畸形患者实施导航辅助矫治与修复重建手术。结果：TBNAVIS—CMFS以清晰的界面和简洁的操作．实现了高精度数字化手术规划;导航辅助的颅颌面骨畸形整复术取得了精确可靠的手术效果,减少了手术创伤。结论：计算机导航技术结合颅颌面整复外科,将有利于从疾病诊断、术前模拟、术中导航等方面推动颅颌面外科趋于精确和微创。     

动态导航系统在口腔种植领域的发展和应用

动态导航系统在口腔种植领域逐渐开始使用,系统能够术前规划种植体植入路径,术中实时可视化追踪种植钻针,避开重要解剖结构,提高手术安全性.本文将简述动态导航系统的发展,组成原理和临床应用,针对不同导航系统辅助常规种植体植入的精度进行探讨,并介绍动态导航系统辅助颧骨种植体植入术的精准度,分析导致临床误差的各种因素.     

Endodontic Microsurgery Using Dynamic Navigation System: A Case Report

Dynamic navigation systems were introduced to facilitate dental implantology by improving the accuracy of dental implant positioning. Dynamic navigation integrates surgical instrumentation and radiologic images by using an optical positioning device controlled by a dedicated computerized interface. These features could help in reducing the risk of unintentional iatrogenic damage to nearby anatomic structures and perform minimally invasive or flapless surgery, leading to reduced patient postoperative discomfort and improved healing. The present case report showed the use of the Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) by an undergraduate student for bone cavity preparation and root-end resection in the surgical endodontic treatment of a lesion in an upper lateral incisor. The system allowed precise localization of the root and precise apicoectomy with a minimal invasive cavity. The dynamic navigation system allowed the student to precisely direct the bur in 3 dimensions. The osteotomy and root-end resection were easily and quickly performed by the undergraduate student with a minimally invasive approach without iatrogenic errors. The navigation system allowed the operator to precisely perform a minimally invasive osteoctomy and root-end resection during endodontic surgery. The development of dedicated surgical navigation systems for endodontic surgery could facilitate the operator's maneuvers and reduce the risk of iatrogenic errors.     

Verification of the usability of a navigation method in dental implant surgery: In vitro comparison with the stereolithographic surgical guide template method

ObjectiveThis study investigates the usefulness of a navigation method using a reference frame directly fixed to the mandible compared to the stereolithographic (STL) surgical guide template method in dental implant surgery.Materials and methodsTwenty rapid prototyping (RP) mandibular models were divided into two groups. Simulation surgery was performed using SimPlant software for both groups. The actual dental implants were placed in the RP models using a real-time navigation system or the surgical guide template, which was fabricated based on STL data by a 3-dimensional printer. Positional implantation errors were measured by comparing the simulation surgery implant positions to the actual postoperative implant positions.ResultsThe vertical distance error of the top surface area in the first molar region was not significantly different between groups. Otherwise, the implantation method using real-time navigation showed greater errors except for the horizontal and vertical errors in the apical area of the canine region.ConclusionThe STL surgical guide template was associated with fewer errors than the real-time navigation method in dental implant surgery.     

Outcomes of orbital decompression using surgical navigation in thyroid-associated ophthalmopathy

Thyroid-associated ophthalmopathy can result in proptosis. In such cases, orbital decompression surgery is often warranted to reduce the adverse impact on patient quality of life. Due to the anatomical complexity of the orbit, navigation can be of considerable assistance during orbital decompression. The objective of this study was to evaluate the benefits of using a surgical navigation device in orbital decompression surgery. A retrospective study was performed based on patients who underwent decompression surgery with (N+) or without (N−) a navigation device between 1997 and 2017. Included patients had undergone unilateral or bilateral orbital decompression by resection of the orbital floor and medial wall of the orbit. Criteria assessed were the presence of debilitating postoperative diplopia, postoperative proptosis reduction, symmetry of protrusion of the eyeballs, and the duration of surgery. Three hundred and fifty eyes were analysed (191 patients): 205 in the N+ group and 145 in the N− group. Use of the surgical navigation system resulted in a greater proptosis reduction, and this result was statistically significant for the right eyeball (P = 0.03). The surgical navigation system had no effect on symmetry of protrusion of the eyeballs or on postoperative diplopia. Setting up the navigation device increased the duration of surgery by 40 minutes on average.     

Computer-aided placement of endosseous oral implants in patients after ablative tumour surgery: assessment of accuracy

The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.     

Registration methods for surgical navigation of the mandible: a systematic review

Image-to-patient registration in navigated mandibular surgery is complex due to the mobile nature of the mandible compared with other craniofacial bones. As a result, surgical navigation is rarely employed in the mandibular region. This systematic review provides an overview of the different registration methods that are used for surgical navigation of the mandible. A systematic search was performed in the MEDLINE Ovid, Scopus, and Embase databases on March 25, 2021. Search terms included synonyms for mandibular surgery, surgical navigation, and registration methods. Articles about navigated mandibular surgery, where the registration method was explicitly mentioned, were included. The database search yielded a total of 2952 articles, from which 81 articles remained for analysis. Four main registration methods were identified: point registration, surface registration, hybrid registration, and computer vision-based registration. The mobility of the mandible is accounted for by either keeping the mandible in a fixed position during preoperative imaging and surgery, or by tracking the mandibular movements. Although different registration methods are available for navigated mandibular surgery, there is always a trade-off between accuracy, registration time, usability, and invasiveness. Future studies should focus on testing the different methods in larger patient studies and should report the registration accuracy.