Soft tissue navigation and image-guided removal of foreign bodies in head and neck surgery

Background. Soft tissue navigation has traditionally been neglected in computer-aided surgery (CAS) because of unpredictable margins of error. In our study, we examined clinical cases in which standard CAS was applied in soft tissue surgery in the head and neck region. Its extended applicability, margins of error, and general performance are described and discussed. Materials and methods. CAS was applied in surgical procedures for six patients. Five patients had foreign bodies in the head and neck region, and one patient displayed uncertain cervical lymph node enlargement. An optoelectrical navigation system (VectorVision(2), BrainLAB) was used in all cases. Results. Using CAS, 10 out of 11 total foreign bodies were identified. Only one glass splinter attached to the eyeball could not be detected by the navigation system. One glass splinter that was deeply buried within the sphenoid bone was easily found but was left untouched. The parapharyngeal lymph node was identified and extracted in a minimally invasive transpalatinal approach. Conclusions. Soft tissue navigation was successfully applied in all but one case; the success was due to the altered demands in soft tissue navigation as opposed to skull-base surgery. Easy identification of foreign bodies and lymph nodes was possible in the soft tissues of the head and neck, with an acceptable margin of error.