Minimal Invasive Navigation-Assisted Removal of Penetrating Metallic Foreign Bodies in the Craniomaxillofacial Region: A Case Report.

Removal of deeply embedded foreign bodies (FBs) in the craniomaxillofacial (CMF) region remains a significant surgical challenge because of the complex anatomy, proximity of critical neurovascular structures, and the limited accuracy of conventional imaging modalities for precise intraoperative localization. Inaccurate localization may increase operative time and the risk of iatrogenic injury. In recent years, there has been a considerable increase in the use of three-dimensional image-guided navigation systems (3D-IGNS) in various maxillofacial procedures, especially the extraction of penetrating FBs in the CMF area. This report describes the clinical application of 3D-IGNS for the safe and accurate removal of penetrating FBs in the CMF region. We present a case report of three patients with retained FBs resulting from gunshot injuries who underwent surgical extraction using 3D-IGNS. Preoperative computed tomography imaging was used for navigation planning, allowing accurate real-time intraoperative localization of the FBs. The navigation system facilitated precise surgical access and guided dissection while minimizing unnecessary tissue manipulation. In all cases, the FBs were accurately localized and successfully removed without significant intraoperative or postoperative complications. The procedures were completed without neurovascular injury or significant postoperative complications, and recovery was uncomplicated. The use of 3D-IGNS enabled precise and minimally invasive surgical approaches, reducing the risk of injury to adjacent vital structures. These cases suggest that 3D-IGNS is a safe and effective tool for managing complex CMF FBs, particularly in maxillofacial trauma cases where accurate localization is crucial to avoid injury to surrounding vital structures.