Application of Augmented Reality to Maxillary Resections: A Three-Dimensional Approach to Maxillofacial Oncologic Surgery

Abstract

In the relevant global context, although virtual reality, augmented reality, and mixed reality have been emerging methodologies for several years, only now have technological and scientific advances made them suitable for revolutionizing clinical care and medical settings through the provision of advanced features and improved healthcare services. Over the past fifteen years, tools and applications using augmented reality (AR) have been designed and tested in the context of various surgical and medical disciplines, including maxillofacial surgery. The purpose of this paper is to show how a marker-less AR guidance system using the Microsoft® HoloLens 2 can be applied in mandible and maxillary demolition surgery to guide maxillary osteotomies. We describe three mandibular and maxillary oncologic resections performed during 2021 using AR support. In these three patients, we applied a marker-less tracking method based on recognition of the patient’s facial profile. The surgeon, using HoloLens 2 smart glasses, could see the virtual surgical planning superimposed on the patient’s anatomy. We showed that performing osteotomies under AR guidance is feasible and viable, as demonstrated by comparison with osteotomies performed using CAD-CAM cutting guides. This technology has advantages and disadvantages. However, further research is needed to improve the stability and robustness of the marker-less tracking method applied to patient face recognition.

15-Year Experience in Maxillofacial Surgical Navigation with Tracked Instruments

“…One of the advantages of virtual planning is the reproducibility of the results, potentially allowing novice surgeons to achieve the same outcomes as more experienced surgeons in case of accurate preoperative planning [22,23].…”

15 Years Experience in Surgical Navigation with Tracked Instruments

“…Notably, positioning these surgical templates requires to perform wider surgical accesses, leading to increased disruption of surrounding healthy tissues and resulting in a more challenging postoperative period with an increased risk of complications. The adoption of intraoperative navigation has emerged as a valuable alternative, offering an effective cost-benefit balance for translating virtual surgical plans into practical procedures, and yielding favorable outcomes in terms of precision and safety [22].…”

“…In some cases, the surgical time was longer than usual for a similar procedure. Robiony et al (2019) performed nasal bone osteotomies using piezoelectric drill tracking [22]. Recently, Alice Dean et al (2022) reported 32 patients who underwent surgery using surgical navigation with tracked piezoelectric.…”

Preclinical Application of Augmented Reality in Pediatric Craniofacial Surgery: An Accuracy Study

“…Unlike Virtual Reality (VR), which creates a totally computer-generated artificial environment, AR uses the real environment and overlays new virtual information on top of it, thus providing a composite view that enhances the user’s sensory perception of the world. Tools and systems employing AR have been designed and tested in the context of several medical applications [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ], including surgical navigation in neurosurgery [ 14 ], craniomaxillofacial surgery [ 1 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], and head and neck oncology [ 22 ].…”