Smartphone-assisted Augmented Reality in Craniofacial Surgery

Abstract

Background: Augmented reality (AR), a blending of both the physical and digital worlds, can be a valid tool for surgeons wishing to plan interventions and attain symmetry. The use of technology has enabled physicians to achieve desirable results. In this article, we describe a method that uses smartphone’s simple AR utilities for convenient, cost effective, and time saving perioperative planning. Methods: Images of preoperative computed tomography, along with 3D reconstructed scans were uploaded to a smartphone and used in an affordable application (Camera Lucida) to superimpose the loaded pictures over the smartphone camera. In one case, a 3D computed tomography scan of the skull was mirrored to help guide fronto-orbital advancement, and in another case the loaded 3D reconstructed computed tomography scan was used to prioritize areas of scalp coverage in a complicated case of craniosynostosis with major scalp wound dehiscence. Discussion: Adaptation of AR to assist in the field of craniofacial surgery has been introduced before in several studies that reported the use of computer-based guidance for cranial reshaping. The majority of these reports used sophisticated modalities, combining advanced image registration and tracking with specialized equipment. The utility of smartphone AR for cranial vault reconstruction provided good accuracy when visualizing fronto-orbital advancement and remodeling, together with in depth prioritization of areas in need of soft tissue reconstruction. Conclusion: Smartphone AR adaptation proved to be a very convenient tool assisting in the planning of different craniofacial conditions that are time saving and do not incur any additional fees beyond those of the surgery.

From Augmented to Virtual Reality in Plastic Surgery: Blazing the Trail to a New Frontier

“…9,10 Craniofacial AR and VR have been widely studied in the field of craniofacial and head and neck surgery, with a particular emphasis on the utility of mixed reality for improved cosmesis and symmetry in both reconstructive and cosmetic procedures of the face, including oral-maxillofacial surgery (OMFS), aesthetic surgery, filler injection, and trauma. 11,12 AR technology has been useful in surgical visualization and navigation for facial contouring surgery, osteotomies, orthognathic surgeries, and neurosurgery. 13 The tumor modeling has been translated to related fields of orthopaedic and gynecologic surgeries for planning resections.…”

“…AR and VR have been widely studied in the field of craniofacial and head and neck surgery, with a particular emphasis on the utility of mixed reality for improved cosmesis and symmetry in both reconstructive and cosmetic procedures of the face, including oral-maxillofacial surgery (OMFS), aesthetic surgery, filler injection, and trauma. 11 12…”

“…25,26 AmplifierVR is distinct from other VR technologies as rather than relying on CT imaging of blood vessels alone, its algorithm identifies and subtracts out subcutaneous fat and muscle from the anatomical reconstruction, optimizing visualization of perforators. 12 A different head-mounted display called the HoloLens uses augmented reality glasses to allow users to view perforators as an anatomical hologram on the patient in real time, allowing the device to be used for both pre-operative planning and intra-operative navigation of the holographic anatomy during dissection. 27 Such technologies endow surgeons with enhanced surgical planning capabilities that can help optimize operative time by allowing for accurate preoperative and intraoperative visualization of complex vascular anatomy.…”

“…AR has also been adapted to smartphones, with CT-based 3D images used to model symmetry in calvarial reshaping for craniosynostosis. 12 3D models with haptic feedback have also been used to virtually test ideal fibular transplant positioning for pedicle anastomosis and skin paddle configuration in mandibulectomies using patient computed tomography angiography (CTA) data. 14 VR has been well-studied in dental implantology, with preoperative cone-beam computed tomography used to create 3D images for planning ideal placement and orientation of dental implants with integration in a variety of named dental guide technologies.…”

Augmented reality navigation for minimally invasive craniosynostosis surgery: a phantom study

“…In craniosynostosis particularly, there have been a few studies that tried to introduce AR for navigation, including Garcia-Mato et al [6] who proposed a smartphone-based AR system that uses 3D photography and marker tracking for patient alignment. Similarly, Alshomer et al [7] used a smartphone based AR system to assist in the planning of cranial vault reshaping. In a different study, Han et al [8] used a camera to track a marker attached to an occlusal splint.…”