Navigation in Trauma Surgery

Abstract

Navigation serves as a reliable tool for the analysis of maxillofacial structures that are difficult to visualize during surgery. Navigation allows the operator to visualize fracture reduction in difficult-to-visualize planes to an accuracy of millimeters while avoiding critical anatomy. Reconstruction of fractures involving the mid-face such as the orbit and zygomaticomaxillary complex benefit significantly from navigation for fracture reduction and restoration of changes to orbital volume, especially in complex cases with significant loss of anatomic landmarks due to trauma. Navigation also allows the safe and accurate retrieval of penetrating bodies in projectile injuries such as gunshot wounds, by decreasing incision length and reducing the time required to detect foreign objects. While navigation is a promising technology, several limitations of the technology include reliance on contralateral unaffected mirrored anatomy as a reference frame, limited applicability in dynamic anatomy such as the mandible, changes in soft tissue structures after surgical pre-planning resulting in structural image drift and the need for operators to undergo extensive training for reliable usability. The applications and effectiveness of navigation are expected to expand in the future with the advent of technologies such as augmented and virtual reality to further integrate and guide the surgeons in the operating field.