Application of surgical navigation technique in removing internal fixation of titanium plates after the zygomatic fracture through mini skin incision

Abstract

Objective The aim of this study was to evaluate the feasibility and convenience with the aid of surgical navigation technique in removing internal fixation of titanium plates after the zygomatic fracture by mini skin incision. Methods Eight patients who need to dismantle the titanium plate after open reduction and internal fixation for zygomatic fracture of zygomatic bone are selected as the experimental group. Preoperatively, all patients received three-dimensional computed tomography scan, and their skulls′ digital imaging data was input into the navigation system workstation to make a virtual surgical plan in advance. During surgery, with the help of real-time navigation technology, a mini skin incision approach was carried out through the skin projection position of the internal fixation device. And combined with intraoral vestibular groove incision and endoscopy technology, according to the design, the internal fixation device was accurately removed. Postoperatively, the amount of bleeding, duration of operation and hospitalization were measured and compared with those cases that had traditional coronal incision approach without the help of surgical navigation (SN) , and VAS questionnaire was also used to assess patients′ satisfaction and the surgery effect. Another eight patients who used the coronal incision to remove the internal fixations of zygomatic arch fracture were selected as the control group. The corresponding indicators were recorded in the control group. The data were processed and analyzed by SPSS 19.0, and the two groups of mean and standard deviation were analyzed by independent sample t test. Results With the help of computer navigation technology, the titanium plate internal fixation device of 8 patients was successfully dismantled by percutaneous mini incision approach, with good postoperative recovery and slight facial scar. The average amount of bleeding of experimental group and control group were (20.00 ± 3.77) mL and (87.50 ± 17.32) mL (t=-10.769, P<0.001) . The duration of hospitalization of experimental group and control group were (1.62 ± 0.51) d and (3.25 ± 0.46) d (t=-7.264, P<0.001) . The VAS questionnaire of experimental group and control group were 2.75 ± 0.70 and 5.50 ± 0.92 (t=-6.677, P<0.001) . There were significant differences in Statistics. Conclusions With the help of surgical navigation technique, the mini skin incision can be used to remove the titanium plates and screws of zygomatic fracture accurately. This operation process is more accurate, less aggressive, and with higher patient satisfaction, which can be regarded as a safe and effective treatment method. But it is not suitable for obese patients and the zygomatic fracture which is fixed by long plates. Key words: Zygomatic fractures; Surgical navigation; Coronal incision; Internal fixiation