PMC4073452_01
On clinical examination reduced mouth opening, increasing restriction in the jaw's latero- and protrusion movement, a right deviation while opening and diffuse pain in the right lower jaw had been noticed since 2 months following inferior alveolar nerve block anesthesia
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F1
He had noticed reduced mouth opening, increasing restriction in the jaw's latero- and protrusion movement, a right deviation during mouth-opening and diffuse pain in the right lower jaw since 2 months [Figure 1].
Magnetic resonance imaging-scan; a 2 cm x 1.7 cm x 2.4 cm sharp defined hypointense suspect mass of 7 mm diameter was detected lateral to the right lateral pterygoid muscle and medial to the right temporal muscle
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F2
An already existing fat saturated 2T-weighted magnetic resonance imaging (MRI) performed at a local hospital showed a 2 cm x 1.7 cm x 2.4 cm sharp defined hypointense mass of 7 mm diameter and an intense contrast enhancement lateral to the right lateral pterygoid muscle and medial to the right temporal muscle [Figure 2].
Reconstruction of high resolution computed tomographydata sets (digital imaging and communications in medicine files) on the navigation workstation (StealthStation TREON plus, Louisville, USA). Reconstruction was depicted in a three-plane view (coronal, axial and sagittal) by the navigation system's software (StealthMergeTM, Medtronic and Louisville, USA). The lesion was visualized as a clear anatomical target for virtual operation access planning
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F3
The performed CT-data sets (standard DICOM files) were preoperatively transferred to the navigation workstation (StealthStation TREON plus, Louisville, USA) and were reconstructed in a three-plane view (coronal, axial and sagittal) by the navigation system's software (StealthMerge , Medtronic, Louisville, USA). Thus the lesion was visualized as a clear anatomical target on the system's navigation monitor in a multiplanar (axial, coronal and sagittal) image formation [Figures 3 and 4].
Preoperative surgical operation access planning in a three plane view on the navigation workstation
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F4
The performed CT-data sets (standard DICOM files) were preoperatively transferred to the navigation workstation (StealthStation TREON plus, Louisville, USA) and were reconstructed in a three-plane view (coronal, axial and sagittal) by the navigation system's software (StealthMerge , Medtronic, Louisville, USA). Thus the lesion was visualized as a clear anatomical target on the system's navigation monitor in a multiplanar (axial, coronal and sagittal) image formation [Figures 3 and 4].
Dynamic reference frame fixed with screws on the patient's skull in contact with the navigation workstation ("line of sight")
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F5
After intubation a dynamic reference frame was fixed with screws on the patient's skull [Figure 5] in visual contact with the three infrared cameras of the navigation workstation ("line of sight").
Navigation workstation. The navigation probe was calibrated for intraoperative computed tomography-tracking and direct visualization on the workstation's monitor by touching the operation field
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F6
Furthermore the navigation probe was calibrated for intraoperative CT-tracking and direct visualization on the workstation's monitor by touching the operation field [Figures 6 and 7].
Navigation probe (front) and reference frame fixed on the patient's skull (back)
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F7
Furthermore the navigation probe was calibrated for intraoperative CT-tracking and direct visualization on the workstation's monitor by touching the operation field [Figures 6 and 7].
Intraoperative navigation; simultaneous, multiplanar (coronal, axial and sagittal) view of the marked lesion
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F8
Under direct visual control using the navigation probe [Figure 8] the described lesion and the surrounding capsulated structure could be excised completely as one specimen [Figure 9].
The lesion and the surrounding capsulated structure could be excised completely as one specimen under direct visual control using the navigation system
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F9
Under direct visual control using the navigation probe [Figure 8] the described lesion and the surrounding capsulated structure could be excised completely as one specimen [Figure 9].