Application of Computer Navigation Technology in Radical Surgery for Advanced Malignant Tumors Involving Maxilla

doi:10.13701/j.cnki.kqyxyj.2023.04.007

Abstract

Abstract: Objective: To explore the application of computer navigation technology in the radical surgery of advanced malignant tumors involving the maxilla. Methods: Fifty-nine patients with advanced malignant tumors involving the maxilla who visited the First Ward of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital from January 2015 to January 2022 were selected and divided into the experimental group and the control group. The application value of computer navigation technology in surgery was analyzed retrospectively. Results: With the help of computer navigation technology, 59 patients successfully completed the surgery. The lesions were completely removed, and the removal scope was close to the skull base and reached the root of the wing plate, ensuring sufficient safe margins for deep surgery. In the experimental group, the average operation time was (6.29±2.76) hours, the average intraoperative bleeding volume was (803.67±321.18) mL, and the positive rate of the incision margin was (3.03±1.33)%. The average operation time of the control group was (7.49±1.50) hours, the average intraoperative bleeding volume was (931.03±337.44) mL, and the positive rate of the incision margin was (8.17±1.90)%. As of September 2022, the maximum survival time of 30 patients in the experimental group was 88 months, the minimum survival time was 5 months, and the average survival time was (36.42±22.35) months. The longest survival time of 29 patients in the control group was 87 months, the shortest survival time was 3 months, and the average survival time was (31.49±24.08) months. One patient in the experimental group needed nasal feeding, and three patients in the control group needed nasal feeding. Conclusion: The computer navigation technology can help surgeons better protect the important anatomical structures of the skull base, better control the safe surgical margin of the posterior deep part of the maxilla, and increase the surgical safety. It has a certain significance in determining the surgical thoroughness of patients with advanced malignant tumors involving the maxilla.

Key words: computer navigation technology, advanced maxillary tumors, safe surgical margin

WU Zhuhao, ZHANG Xingwei, SUN Yawei, LI Zihui, CHEN Xin, PU Yumei, DONG Yingchun, SUN Guowen. Application of Computer Navigation Technology in Radical Surgery for Advanced Malignant Tumors Involving Maxilla[J]. Journal of Oral Science Research, 2023, 39(4): 322-327.

References

[1] Demian N, Pearl C, Woernley TC 3rd, et al.Surgical navigation for oral and maxillofacial surgery [J]. Oral Maxillofac Surg Clin North Am, 2019, 31(4):531-538.
[2] Brennan PA, Dylgjeri F, Coletta RD, et al. Surgical tumour margins and their significance in oral squamous cell carcinoma [J]. J Oral Pathol Med, 2022, 51(4):311-314.
[3] Brouwer de Koning SG, Geldof F,van Veen RLP, et al. Electromagnetic surgical navigation in patients undergoing mandibular surgery [J]. Sci Rep, 2021, 11(1):4657.
[4] Ricotta F, Cercenelli L, Battaglia S, et al. Navigation-guided resection of maxillary tumors: Can a new volumetric virtual planning method improve outcomes in terms of control of resection margins? [J]. J Craniomaxillofac Surg, 2018, 46(12):2240-2247.
[5] 翦新春.翼腭窝及翼腭窝邻近结构中良、恶性肿瘤的诊断与外科处理[J].口腔颌面外科杂志,2012,22(1):1-7.
[6] Schramm A, Suarez-Cunqueiro MM, Barth EL, et al. Computer-assisted navigation in craniomaxillofacial tumors [J]. J Craniofac Surg, 2008, 19(4):1067-1074.
[7] Feichtinger M, Pau M, Zemann W, et al. Intraoperative control of resection margins in advanced head and neck cancer using a 3D-navigation system based on PET/CT image fusion [J]. J Craniomaxillofac Surg, 2010, 38(8):589-594.
[8] 付坤,鲁涵,高宁,等.虚拟手术计划联合术中导航辅助上颌骨肿瘤切除及同期修复[J].中华整形外科杂志,2022,38(1):46-51.
[9] Jian XC, Liu JP. A new surgical approach to extensive tumors in the pterygomaxillary fossa and the skull base [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003, 95(2):156-162.
[10] Tarsitano A, Ricotta F, Baldino G, et al. Navigation-guided resection of maxillary tumours: The accuracy of computer-assisted surgery in terms of control of resection margins-A feasibility study [J]. J Craniomaxillofac Surg, 2017, 45(12):2109-2114.
[11] 闫志伟,李欢,杨子桧,等.导航手术在头颈肿瘤切除及重建中的临床应用[J].肿瘤预防与治疗,2021,34(12):1123-1130.
[12] Hasan W, Daly MJ, Chan HHL, et al. Intraoperative cone-beam CT-guided osteotomy navigation in mandible and maxilla surgery [J]. Laryngoscope, 2020, 130(5):1166-1172.
[13] Shamir RR, Joskowicz L. Geometrical analysis of registration errors in point-based rigid-body registration using invariants [J]. Med Image Anal, 2011, 15(1):85-95.
[14] Widmann G, Stoffner R, Bale R. Errors and error management in image-guided craniomaxillofacial surgery [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 107(5):701-715.
[15] Yu H, Shen SG, Wang X, et al. The indication and application of computer-assisted navigation in oral and maxillofacial surgery-Shanghai's experience based on 104 cases [J]. J Craniomaxillofac Surg, 2013, 41(8):770-774.
[16] Catanzaro S, Copelli C, Manfuso A, et al. Intraoperative navigation in complex head and neck resections: indications and limits [J]. Int J Comput Assist Radiol Surg, 2017, 12(5):881-887.