Accuracy of Navigated Osteotomies in Rhinoplasty: A Cadaveric Analysis

Background Navigation guided rhinoplasty allows detailed planning and guidance of osteotomies. We aimed to investigate whether the use of a CT navigation system is feasible and capable of performing more precise osteotomies at specific locations, thus improving accuracy. Methods Bilateral electromagnetic‐navigated osteotomies ( n = 18) of the nasomaxillary suture were performed on nine cadaver heads, using a transnasal ( n = 4) or percutaneous ( n = 14) technique. After dissection, we manually assessed the distance between the osteotomy and the suture on ( n = 5) specimens. Additionally, at baseline and postoperatively, a cone beam computed tomography was performed to calculate the mean and median distance between the osteotomy and the suture line. Results The manually measured mean distance from intended to actual osteotomy was 0.75 mm (mm) (95% confidence interval [CI] 0.06–1.44 mm) with a median distance of 0.00 mm (interquartile range [IQR] 0.00–1.19 mm). In 6 of 10 procedures, the osteotomy was created according to plan with no visible deviation. Overall, on imaging, the navigation‐guided osteotomies deviated from the suture by an average of 1.50 mm (95% CI 0.87–2.12 mm) with a standard deviation (SD) of 1.35 mm. The median distance was 0.73 mm (IQR 0.59–2.61 mm). The accuracies of transnasal and percutaneous osteotomies were similar ( p = 0.63). Conclusion Navigation‐guided osteotomies demonstrated good feasibility with clinically useful sub‐millimeter accuracy for both percutaneous and transnasal techniques. A model for postoperative outcome analysis is described with clinically useful accuracy, though not as high as direct observation. Level of Evidence N/A.