Computer-aided insertion of endosteal implants in the zygoma: a pilot study

Wolfgang Birkfellner; Franz Watzinger; Felix Wanschitz; F. Ziya; J. Kremser; A. Potyka; R. Mayr; Klaus Huber; F. Kainberger; Rolf Ewers; Helmar Bergmann

doi:10.1117/12.383048

18 April 2000 Computer-aided insertion of endosteal implants in the zygoma: a pilot study

Wolfgang Birkfellner, Franz Watzinger, Felix Wanschitz, F. Ziya, J. Kremser, A. Potyka, R. Mayr, Klaus Huber, F. Kainberger, Rolf Ewers, Helmar Bergmann

Author Affiliations +

Proceedings Volume 3976, Medical Imaging 2000: Image Display and Visualization; (2000) https://doi.org/10.1117/12.383048
Event: Medical Imaging 2000, 2000, San Diego, CA, United States

Abstract

Endosteal implants facilitate obturator prosthesis fixation in tumor patients after maxillectomy. Previous clinical studies shown however, that survival of implants placed into available bone after maxillectomy is generally poor. Implants positioned optimally in residual zygomatic bone provide superior stability form a biomechanical point of view as well as improved survival. In a pilot study, we have assessed the precision of VISIT, a surgical navigation system developed for research purposes at our institution. VISIT is based on the AVW-library and a number of in-house developed algorithms for communication with an optical tracker and patient-to-CT-registration. The final platform independent application was assembled within 6 man-months using ANSI-C and Tcl/Tk. Five cadaver specimens underwent hemimaxillectomy. The cadaver head was matched to a preoperative high resolution CT by using implanted surgical microscrews as fiducial markers. The position of a surgical drill relative to the cadaver head was determined with an optical tracking system. Implants were placed into the zygomatic arch where maximum bone volume was available. The results were assessed using test for allocation accuracy and postoperative CT-scans of the cadaver specimens. The average allocation accuracy of landmarks on the bony skull was 0.6 +/- 0.3 mm determined with a 5 degree-of-freedom pointer probe. The allocation accuracy of the tip of the implant burr was 1.7 +/- 0.4 mm. The accuracy of the implant position compared to the planned position was 1.5 +/- 1.1 mm. 8 out of 10 implants were inserted with maximum contact to surrounding bone, two implants were located unfavorably. However, reliable placement of implants in this region is difficult to achieve. The techqni3u described in this paper may be very helpful in the management of patients after maxillary resection without sufficient retention for obturator prostheses.

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Wolfgang Birkfellner, Franz Watzinger, Felix Wanschitz, F. Ziya, J. Kremser, A. Potyka, R. Mayr, Klaus Huber, F. Kainberger, Rolf Ewers, and Helmar Bergmann "Computer-aided insertion of endosteal implants in the zygoma: a pilot study", Proc. SPIE 3976, Medical Imaging 2000: Image Display and Visualization, (18 April 2000); https://doi.org/10.1117/12.383048

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KEYWORDS

Bone

Computed tomography

Surgery

Visualization

Light emitting diodes

Optical tracking

Head

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