Image-Guided Navigation in Optimizing Surgical Management of Craniomaxillofacial Fibrous Dysplasia

Abstract

Fibrous dysplasia is a benign developmental dysplastic disorder of the bone in which abnormal fibroblastic proliferation replaces the normal bone matrix. Craniomaxillofacial fibrous dysplasia can cause severe deformity with devastating functional and aesthetic consequence. Precise surgical removal of the fibro-osseous tissue is the key to ultimately restore normal function and aesthetics. Navigational surgical tool has become a useful adjunct in the surgical management of the craniomaxillofacial skeleton. Thirteen patients with facial asymmetry and deformity caused by craniomaxillofacial fibrous dysplasia were enrolled into this study. With preoperative planning and three-dimensional simulation, normal anatomic contours of the deformed area were recreated by superimposing unaffected to the affected side. After registration, surgical facial recontouring was performed under the guidance of navigation system. Good accuracy was achieved with the registration of patient's facial skeleton and preoperative three-dimensional reconstructed model in all the cases. With intraoperative navigational guidance, facial bone recontouring was performed uneventfully in all cases. Surgical accuracy was evaluated by comparing the preoperative and postoperative computed tomography scan measurement. The mean maximum discrepancy between the actual surgical reduction and preoperative planning was less than 2 mm. Symptoms associated with optical nerve compression were eliminated in affected individuals. All patients' facial symmetry and aesthetics were improved. Navigation-guided facial bone recontouring is a valuable treatment modality in managing craniomaxillofacial fibrous dysplasia.