Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery

• Published in: Journal of cranio-maxillo-facial surgery 2008-03, Vol.36 (2), p.109-116
• Main Authors: Luebbers, Heinz-Theo, MD, DMD, Messmer, Peter, PD MD, Obwegeser, Joachim Anton, PD MD, DMD, Zwahlen, Roger Arthur, MD, DMD, Kikinis, Ron, MD, Graetz, Klaus Wilhelm, MD, DMD, Matthews, Felix, MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Bone Screws; comparative study; Contrast Media; Dentistry; Facial Bones - surgery; Humans; Imaging, Three-Dimensional - methods; Lasers; Medical sciences; Models, Anatomic; Occlusal Splints; Orbit; Otorhinolaryngology. Stomatology; Patient Care Planning; Phantoms, Imaging; Surgery; Surgery, Computer-Assisted; surgery, maxillofacial; tomography, X-ray; Tomography, X-Ray Computed
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2007.09.002

Summary Background Surgical navigation requires registration of the pre-operative image dataset with the patient in the operation theatre. Various marker and marker-free registration techniques are available, each bearing an individual level of precision and clinical practicability. In this study the precision of four different registration methods in a maxillofacial surgical setting is analyzed. Materials and methods A synthetic full size human skull model was registered with its computer tomography-dataset using (a) a dentally mounted occlusal splint, (b) the laser surface scanning, (c) five facial bone implants and (d) a combination of dental splint and two orbital bone implants. The target registration error was computed for 170 landmarks spread over the entire viscero- and neurocranium in 10 repeats using the VectorVision2® (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical analyses were performed by anatomical region. Results An average precision of 1 mm was found for the periorbital region irrespective of registration method (range 0.6–1.1 mm). Beyond the mid-face, precision linearly decreases with the distance from the reference markers. The combination of splint with two orbital bone markers significantly improved precision from 1.3 to 0.8 mm ( p < 0.001) on the viscerocranium and 2.3–1.2 mm ( p < 0.001) on the neurocranium. Conclusions An occlusal splint alone yields poor precision for navigation beyond the mid-face. The precision can be increased by combining an occlusal splint with just two bone implants inserted percutaneously on the lateral orbital rim of each side.