Surgical management of maxillofacial fibrous dysplasia under navigational guidance

Abstract

Fibrous dysplasia is a benign and slowly progressive disorder of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Precise excision of the lesion is crucial to restore function and aesthetics. We present our experience using surgical navigation technology for the recontouring of the faces of 8 patients with maxillofacial fibrous dysplasia who were treated from 2012–2013, all of whom were thought suitable for surgical recontouring. Preoperative computed tomography (CT) scans were used to make a virtual plan based on the patient's mirrored anatomy. During the operation we fixed a rigid digital reference frame to the patient's forehead or mandible, depending on the site of the lesion. The patient and the virtual image were matched through an individual recording technique. A pointing device was in constant use to find out whether the extent of resection was consistent with the preoperative design, and we assessed the surgical outcome by fusion of the preoperative planning and postoperative CT reconstruction images. The acquisition of the data sets was uncomplicated, and the use of surgical navigation improved the safety and the accuracy of the recontouring. There were no complications during 1–2 years follow up. Navigational guidance based on a virtual plan is safe and accurate, and is of value in the management of maxillofacial fibrous dysplasia.