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01.09.2009 | Original Article | Ausgabe 3/2009

Oral and Maxillofacial Surgery 3/2009

The use of navigation (BrainLAB Vector vision2) and intraoperative 3D imaging system (Siemens Arcadis Orbic 3D) in the treatment of gunshot wounds of the maxillofacial region

Zeitschrift:
Oral and Maxillofacial Surgery > Ausgabe 3/2009
Autoren:
Alexander Gröbe, Christoph Weber, Rainer Schmelzle, Max Heiland, Jan Klatt, Philipp Pohlenz

Abstract

Purpose

Gunshot wounds are a rare occurance during times of peace. The removal of projectiles is recommended; in some cases, however, this is a controversy. The reproduction of a projectile image can be difficult if it is not adjacent to an anatomical landmark. Therefore, navigation systems give the surgeon continuous real-time orientation intraoperatively. The aim of this study was to report our experiences for image-guided removal of projectiles and the resulting intra- and postoperative complications.

Patients and methods

We investigated 50 patients retrospectively; 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region. Eighteen had surgical removal of projectiles without navigation assistance.

Results

There was a significant correlation (p = 0.0136) between the navigated surgery vs. not-navigated surgery and complicaton rate, including major bleeding (n = 4 vs. n = 1, 8% vs. 2%), soft tissue infections (n = 7 vs. n = 2, 14% vs. 4%), and nerval damage (n = 2 vs. n = 0, 4% vs. 0%; p = 0.038) and between the operating time and postoperative complications. A high tendency between operating time and navigated surgery (p = 0.1103) was shown. When using navigation system, we could reduce operating time.

Conclusion

In conclusion, there is a significant correlation between reduced intra- and postoperative complications, including wound infections, nerval damage, and major bleeding, and the appropriate use of a navigation system. In all these cases, we could present reduced operating time. Cone-beam computed tomography plays an important role in detecting projectiles or metallic foreign bodies intraoperatively.

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