Oral and Maxillofacial Surgery

, Volume 13, Issue 3, pp 153–158 | Cite as

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

  • Alexander Gröbe
  • Christoph Weber
  • Rainer Schmelzle
  • Max Heiland
  • Jan Klatt
  • Philipp Pohlenz
Original Article



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.


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.


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.


Gunshot wounds Projectiles Imaging techniques Cone-beam computed tomography Navigated surgery 



We acknowledge Dr. Henning Hanken for his help and valuable comments on the manuscript.

Conflict of interest statement

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Alexander Gröbe
    • 1
  • Christoph Weber
    • 2
  • Rainer Schmelzle
    • 1
  • Max Heiland
    • 3
  • Jan Klatt
    • 1
  • Philipp Pohlenz
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of Oral and Maxillofacial SurgeryClinic of Bremerhaven-ReinkenheideBremerhavenGermany

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