# Computer-Assisted Intraoperative Navigation in Pediatric Head and Neck Surgical Oncology: A Single-Center Case Series and Scoping Review of the Literature

## TL;DR

Intraoperative navigation helps surgeons perform more precise and confident operations in pediatric head and neck cancer surgery.

## Contribution

This study combines a literature review and institutional case series to demonstrate the practical benefits of intraoperative navigation in pediatric head and neck oncology.

## Key findings

- Intraoperative navigation consistently aided in identifying anatomy, delineating tumor margins, and confirming resection depth.
- A single-center case series showed a 100% rate of negative-margin resections when using iNav.
- Authors uniformly endorsed iNav as a useful tool in complex or previously operated surgical fields.

## Abstract

Our review and institutional experience highlight the emerging yet meaningful role of intraoperative navigation (iNav) in pediatric head and neck surgical oncology. Across the twenty-seven cases identified in the literature and the five cases from our center, iNav consistently supported surgeons in identifying patient-specific anatomy, delineating tumor margins, and confirming the depth and adequacy of resection. Although the available evidence is largely limited to lower-level studies, the authors uniformly endorsed iNav as a useful adjunct, particularly in anatomically complex or previously operated fields, despite manageable limitations related to registration and tissue manipulation. Our single-center experience to date further demonstrates a complete rate of negative-margin resections with its use. Taken together, these findings reinforce that iNav enhances operative confidence and precision in pediatric head and neck cancer surgery, supporting its continued integration as a tool that may help balance oncologic completeness with minimizing surgical morbidity.

Background: As pediatric head and neck cancer (pHNC) incidence increases, the development of new surgical oncology techniques to reduce morbidity are essential. Intraoperative navigation (iNav) represents the most translatable technology among both the model-comparative and integrative surgical navigation technologies to optimize surgical outcomes. Methods: A scoping review of the literature was performed according to PRISMA guidelines from 1970 to present (February 2025), investigating the use of iNav in cases of pHNC. Patient case details and authors’ perception of iNav’s utility were analyzed. A single-center retrospective case series review (September 2022 to September 2025) of the senior authors’ experience employing iNav in pHNC cases was also performed. Results: The scoping review identified twenty-seven cases of pHNC from sixteen studies that both utilized iNav and met the inclusion criteria. Many of the authors commented favorably on the utility of iNav technology, while concurrently agreeing upon its limitations. The case series review identified five cases of pHNC that met the inclusion criteria. This small case series revealed a 100% R0 resection rate with the use of iNav in four pHNC resections. The fifth case used iNav for biopsy site selection. Conclusions: The results of our scoping review as well as our institutional experience with this technology demonstrate its utility in guiding surgical approach, confirming depth of resection, and navigating marginal assessment. This study was limited by incidental and incomplete reporting of iNav’s clinical application to pHNC; several extensive institutional reports had to be excluded due to insufficiently detailed data linkage. Our review builds upon the existing pediatric surgical literature, anchoring the evidentiary justification for the application of iNav to pediatric head and neck surgery.