Removal of small foreign bodies from the maxillary sinus using CT image-guided surgical navigation and rapid paired-point registration and calibration with reference markers on an occlusal splint

Abstract

Computed tomography (CT)-guided surgical navigation is useful for removing foreign bodies from the maxillofacial region. Accuracy and speed of registration and intraoperative calibration are essential for functional intraoperative navigation. A case in which foreign bodies were removed from the maxillary sinus using paired-point registration and calibration with reference markers on an occlusal splint for CT-guided surgical navigation is reported. A 49-year-old woman presented with spontaneous right cheek pain. Panoramic radiography showed two foreign bodies in her right maxillary sinus. Under general anesthesia, an occlusal splint with reference markers was set on the maxillary dental arch, and the anterior wall of the maxillary sinus was exposed. Foreign bodies were identified using an infrared optical Kick® Navigation System (Brainlab AG, Munich, Germany). The anterior wall of the maxillary sinus closest to the foreign bodies was penetrated with a trephine bur, the foreign bodies were removed, and the wound was completely closed. Several repeated calibrations were required to obtain accurate positional information about the foreign bodies during the surgery, but these were completed within 30 seconds. Histopathological findings and the postoperative clinical course indicated that the spontaneous right cheek pain was due to maxillary sinusitis with granulomatous inflammation caused by the foreign bodies. CT-guided surgical navigation using an occlusal splint with reference markers was useful for locating the foreign bodies in this patient, and rapid calibration allowed accurate positional information to be obtained during surgery to remove them from the maxillary sinus.