A novel protocol for planning and navigation in cranio-facial surgery: a preclinical surgical study

Publication date: Available online 10 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Leonardo Franz, Miriam Isola, Daniele Bagatto, Ferdinando Calzolari, Luciana Travan, Massimo Robiony
PurposeIn modern craniofacial surgery, the accuracy of osteotomies plays a central role in the surgical technique. To reach a higher level of accuracy, many centers employ virtual pre-surgical planning. In the last decade, some surgeons have also applied navigational approaches to craniofacial procedures.In this work, a novel protocol for surgical planning and intraoperative navigation is described and validated in a pre-clinical setting to determine its accuracy in guiding osteotomies.Materials and methodsThis study is based on planning a set of osteotomies using 3D models of CT images of human skulls. The planned osteotomies have been reproduced on real skulls using an optical infra-red navigation system. The positions of performed osteotomies and planned osteotomies have been compared. The results have been described as the mean positional error and as Lin's concordance coefficient. Bland and Altman's interval of agreement has also been defined to assess a range that could include 95% of possible errors.ResultsThe mean error was 0.044 mm (I.C. 95%: -0.128; +0.216 mm), Lin's concordance interval was 0.999 (I.C.95%: 0.999; 1.000), Bland and Altman's limits of agreement ranged from -1.500 to +1.589 mm.ConclusionsThese results demonstrate a submillimetric mean error and a very narrow interval of agreement, providing pre-clinical validation of this new protocol and suggesting that it could be applied in a clinical setting.



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