Intraoperative Navigation in Orthognathic Surgery: Mitigating Iatrogenic Complications

Area of Science:

• Oral and Maxillofacial Surgery
• Surgical Navigation Technologies

Background:

• Orthognathic surgery involves intricate skeletal manipulation near vital neurovascular and airway structures.
• Iatrogenic injuries, though rare, can lead to severe outcomes such as stroke, blindness, and death.
• Existing technologies focus on positional accuracy, not patient safety enhancement.

Purpose of the Study:

• To review the adoption and outcomes of intraoperative navigation in orthognathic surgery.
• To assess the potential of intraoperative navigation in reducing iatrogenic complications.

Main Methods:

• Systematic literature search following PRISMA guidelines across major databases (PubMed, Embase, Web of Science, Cochrane Library).
• Inclusion of 30 original studies reporting on intraoperative navigation in orthognathic surgery.
• Data extraction on indications, procedures, technologies, usage purpose, and outcomes.

Main Results:

• Most studies (96.7%) utilized navigation for skeletal positioning accuracy; few (6.7%) reported its use for avoiding critical structures.
• BrainLab, Stryker, and Aurora/Northern Digital Inc. were the most common navigation systems.
• Evidence from other specialties confirms navigation's efficacy in reducing injury, blood loss, and operative time.

Conclusions:

• Intraoperative navigation is a highly accurate tool for orthognathic surgery.
• Its potential for mitigating severe iatrogenic complications is under-explored in current literature.
• Further high-level studies are needed to focus on complication prevention in orthognathic surgery using navigation.