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Application of surgical navigation in styloidectomy for treating Eagle's syndrome.

Dou G, Zhang Y, Zong C, Chen Y, Guo Y, Tian L - Ther Clin Risk Manag (2016)

Bottom Line: Postoperatively, the amount of bleeding, duration of operation and hospitalization, and the length of resected styloid process (SP) were measured and compared with those cases that had traditional styloidectomy without the help of surgical navigation (SN).The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients' symptoms were improved greatly, and two patients had some improvement.The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle's syndrome.

View Article: PubMed Central - PubMed

Affiliation: The First Brigade of Students, The Fourth Military Medical University, Xi'an, People's Republic of China.

ABSTRACT

Purpose: The present study aimed to evaluate the feasibility, accuracy, and clinical effect of intraoperative navigation for resection of elongated styloid process (ESP) in Eagle's syndrome.

Patients and methods: Twelve patients with Eagle's syndrome with clinically and radiologically established diagnoses of ESP were included in this study. Preoperatively, all patients accepted three-dimensional computed tomography scan, and their skulls' digital imaging and communications in medicine data were inputed into the navigation system workstation to make a virtual surgical plan in advance. During surgery, the intraoperative navigation was performed to excise the ESP accurately for both intraoral (without tonsillectomy) and extraoral approaches following the virtual plan. Postoperatively, the amount of bleeding, duration of operation and hospitalization, and the length of resected styloid process (SP) were measured and compared with those cases that had traditional styloidectomy without the help of surgical navigation (SN). A simple visual analog scale questionnaire was also used to assess patients' satisfaction and the surgery effect after 3 months.

Results: In total, 17 SPs from 12 patients were precisely resected by intraoral parapharyngeal approach and small cervical approach with the aid of SN. No severe complications occurred in any patients. The length of resected SPs was 21.93±14.26 mm. The average amount of bleeding and duration of operation were 22.50±8.54 mL and 40.35±11.81 minutes, respectively, which were all less than with traditional styloidectomy. The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients' symptoms were improved greatly, and two patients had some improvement.

Conclusion: The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle's syndrome.

No MeSH data available.


Related in: MedlinePlus

Preoperative analysis of the ESP in navigation workstation.Notes: Patient’s 3D-CT data were input into the navigation workstation to locate and measure the SP precisely, which showed its length was 40.8 mm (A). The virtual ESP was clearly seen using the software iPlan, and the resection spot was marked with green, while the residual was marked with red (B).Abbreviations: 3D-CT, three-dimensional computed tomography; ESP, elongated styloid process; SP, styloid process.
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f1-tcrm-12-575: Preoperative analysis of the ESP in navigation workstation.Notes: Patient’s 3D-CT data were input into the navigation workstation to locate and measure the SP precisely, which showed its length was 40.8 mm (A). The virtual ESP was clearly seen using the software iPlan, and the resection spot was marked with green, while the residual was marked with red (B).Abbreviations: 3D-CT, three-dimensional computed tomography; ESP, elongated styloid process; SP, styloid process.

Mentions: A 56-year-old man came to our unit complaining of persistent and aggravated throat pain, and foreign body sensation in the right side over 3 years. He also experienced vague dull pains around the right lower face, although he had no face and head trauma history. He had been diagnosed for temporomandibular joint disorders and accepted medication therapy but had experienced little improvement. On physical examination, a hard strip body could be palpated in the top of right tonsillar fossa and his symptoms could be relieved by local injection of lidocaine. 3D-CT scan revealed that he had an SP of 40.8 mm in the right side, extending inferiorly toward the angle of the mandible. On the basis of these clinical and radiographic findings, Eagle’s syndrome was diagnosed. After a deep discussion with us, the patient decided to have the right SP resected to relieve his symptoms. His 3D-CT data were input into the navigation workstation, and a surgical plan was made by iPlan, which indicated the SP location, shape, and resection spot (Figure 1). Under general anesthesia, a 1.5 cm parapharyngeal incision was chosen with help from the real-time navigation technique. The incision located in the mucosa superolateral to pharyngopalatine arch and superior to tonsillar bed, which was very close to the tip of SP (Figure 2). After mucosa was cut, the ligament and muscles around SP were stripped off either by blunt dissection with curved hemostatic forceps or by scissor cutting. Then the EM pointer was inserted into the wound and moved along with the bony SP to find the planned resection spot, which was shown on the screen (Figure 3). In this way, the important anatomy structures around SP were protected without massive dissection. Then the SP was pinched off by a Stellbrink bone rongeur at the planned spot. The resected SP was taken out of the mouth, and the wound was closed by resorbable sutures. The patient received intravenous cefalotin 1.0 g just before the beginning of the operation and every 8 hours at the hospital for a period of 24 hours and then an oral administration of amoxicillin 500 mg every 8 hours for 3 days more as an outpatient. At 1 month postoperatively, the mucosa wound healed well, and the patient was pleased to report that his previous symptoms of pain and foreign body sensation had resolved. He was subsequently discharged.


Application of surgical navigation in styloidectomy for treating Eagle's syndrome.

Dou G, Zhang Y, Zong C, Chen Y, Guo Y, Tian L - Ther Clin Risk Manag (2016)

Preoperative analysis of the ESP in navigation workstation.Notes: Patient’s 3D-CT data were input into the navigation workstation to locate and measure the SP precisely, which showed its length was 40.8 mm (A). The virtual ESP was clearly seen using the software iPlan, and the resection spot was marked with green, while the residual was marked with red (B).Abbreviations: 3D-CT, three-dimensional computed tomography; ESP, elongated styloid process; SP, styloid process.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835116&req=5

f1-tcrm-12-575: Preoperative analysis of the ESP in navigation workstation.Notes: Patient’s 3D-CT data were input into the navigation workstation to locate and measure the SP precisely, which showed its length was 40.8 mm (A). The virtual ESP was clearly seen using the software iPlan, and the resection spot was marked with green, while the residual was marked with red (B).Abbreviations: 3D-CT, three-dimensional computed tomography; ESP, elongated styloid process; SP, styloid process.
Mentions: A 56-year-old man came to our unit complaining of persistent and aggravated throat pain, and foreign body sensation in the right side over 3 years. He also experienced vague dull pains around the right lower face, although he had no face and head trauma history. He had been diagnosed for temporomandibular joint disorders and accepted medication therapy but had experienced little improvement. On physical examination, a hard strip body could be palpated in the top of right tonsillar fossa and his symptoms could be relieved by local injection of lidocaine. 3D-CT scan revealed that he had an SP of 40.8 mm in the right side, extending inferiorly toward the angle of the mandible. On the basis of these clinical and radiographic findings, Eagle’s syndrome was diagnosed. After a deep discussion with us, the patient decided to have the right SP resected to relieve his symptoms. His 3D-CT data were input into the navigation workstation, and a surgical plan was made by iPlan, which indicated the SP location, shape, and resection spot (Figure 1). Under general anesthesia, a 1.5 cm parapharyngeal incision was chosen with help from the real-time navigation technique. The incision located in the mucosa superolateral to pharyngopalatine arch and superior to tonsillar bed, which was very close to the tip of SP (Figure 2). After mucosa was cut, the ligament and muscles around SP were stripped off either by blunt dissection with curved hemostatic forceps or by scissor cutting. Then the EM pointer was inserted into the wound and moved along with the bony SP to find the planned resection spot, which was shown on the screen (Figure 3). In this way, the important anatomy structures around SP were protected without massive dissection. Then the SP was pinched off by a Stellbrink bone rongeur at the planned spot. The resected SP was taken out of the mouth, and the wound was closed by resorbable sutures. The patient received intravenous cefalotin 1.0 g just before the beginning of the operation and every 8 hours at the hospital for a period of 24 hours and then an oral administration of amoxicillin 500 mg every 8 hours for 3 days more as an outpatient. At 1 month postoperatively, the mucosa wound healed well, and the patient was pleased to report that his previous symptoms of pain and foreign body sensation had resolved. He was subsequently discharged.

Bottom Line: Postoperatively, the amount of bleeding, duration of operation and hospitalization, and the length of resected styloid process (SP) were measured and compared with those cases that had traditional styloidectomy without the help of surgical navigation (SN).The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients' symptoms were improved greatly, and two patients had some improvement.The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle's syndrome.

View Article: PubMed Central - PubMed

Affiliation: The First Brigade of Students, The Fourth Military Medical University, Xi'an, People's Republic of China.

ABSTRACT

Purpose: The present study aimed to evaluate the feasibility, accuracy, and clinical effect of intraoperative navigation for resection of elongated styloid process (ESP) in Eagle's syndrome.

Patients and methods: Twelve patients with Eagle's syndrome with clinically and radiologically established diagnoses of ESP were included in this study. Preoperatively, all patients accepted three-dimensional computed tomography scan, and their skulls' digital imaging and communications in medicine data were inputed into the navigation system workstation to make a virtual surgical plan in advance. During surgery, the intraoperative navigation was performed to excise the ESP accurately for both intraoral (without tonsillectomy) and extraoral approaches following the virtual plan. Postoperatively, the amount of bleeding, duration of operation and hospitalization, and the length of resected styloid process (SP) were measured and compared with those cases that had traditional styloidectomy without the help of surgical navigation (SN). A simple visual analog scale questionnaire was also used to assess patients' satisfaction and the surgery effect after 3 months.

Results: In total, 17 SPs from 12 patients were precisely resected by intraoral parapharyngeal approach and small cervical approach with the aid of SN. No severe complications occurred in any patients. The length of resected SPs was 21.93±14.26 mm. The average amount of bleeding and duration of operation were 22.50±8.54 mL and 40.35±11.81 minutes, respectively, which were all less than with traditional styloidectomy. The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients' symptoms were improved greatly, and two patients had some improvement.

Conclusion: The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle's syndrome.

No MeSH data available.


Related in: MedlinePlus