Introduction: Nager syndrome is a rare genetic condition characterized by defects primarily of the face, arms, and hands. Children with Nager syndrome are frequently born with maxillary hypoplasia in conjunction with micrognathia and associated cleft lip/palate anomalies. These abnormalities severely restrict proper feeding, impair normal speech and language development, and contribute to life-threatening breathing problems. Surgical management options include mandibular osteotomy and distraction osteogenesis to correct the maxillofacial defects. Operative complications include damage to surrounding nerves and vessels, entry to the skull base, and recurrent temporomandibular joint (TMJ) ankylosis.
Case Report: Nine-year-old girl with Nager syndrome presents for recurrent bilateral TMJ ankylosis. SuRgical PlannerTM surgical rehearsal platform (SRP) was used in conjunction with Brainlab intraoperative computed tomography (CT) navigation system to decrease operative time, enhance visualization of key anatomical landmarks and extent of dissection, and minimize intraoperative risks and complications.
Conclusion: SRP and Brainlab intraoperative CT navigation system first developed for neurosurgery have been successfully applied to craniofacial procedures. This case highlighted the synergistic benefit of SRP and Brainlab image guidance software to enhance a surgeon’s ability to increase operative efficiency, minimize surgical complications, and improve overall patient outcome.

Keywords: Brainlab, Craniofacial, Distraction osteogenesis, Mandibular osteotomy, Nager syndrome, Surgical planner