Abstract
ObjectiveTo evaluate the feasibility and accuracy of mixed reality combined with surgical navigation in oral and maxillofacial tumor surgery.MethodsRetrospective analysis of data of seven patients with oral and maxillofacial tumors who underwent surgery between January 2019 and January 2021 using a combination of mixed reality and surgical navigation. Virtual surgical planning and navigation plan were based on preoperative CT datasets. Through IGT-Link port, mixed reality workstation was synchronized with surgical navigation, and surgical planning data were transferred to the mixed reality workstation. Osteotomy lines were marked with the aid of both surgical navigation and mixed reality images visualized through HoloLens. Frozen section examination was used to ensure negative surgical margins. Postoperative CT datasets were obtained 1 week after the surgery, and chromatographic analysis of virtual osteotomies and actual osteotomies was carried out. Patients received standard oncological postoperative follow-up.ResultsOf the seven patients, four had maxillary tumors and three had mandibular tumors. There were total of 13 osteotomy planes. Mean deviation between the planned osteotomy plane and the actual osteotomy plane was 1.68 ± 0.92 mm; the maximum deviation was 3.46 mm. Chromatographic analysis showed error of ≤3 mm for 80.16% of the points. Mean deviations of maxillary and mandibular osteotomy lines were approximate (1.60 ± 0.93 mm vs. 1.86 ± 0.93 mm). While five patients had benign tumors, two had malignant tumors. Mean deviations of osteotomy lines was comparable between patients with benign and malignant tumors (1.48 ± 0.74 mm vs. 2.18 ± 0.77 mm). Intraoperative frozen pathology confirmed negative resection margins in all cases. No tumor recurrence or complications occurred during mean follow-up of 15.7 months (range, 6-26 months).ConclusionThe combination of mixed reality technology and surgical navigation appears to be feasible, safe, and effective for tumor resection in the oral and maxillofacial region.
Highlights
The oral and maxillofacial region is anatomically complex, housing many vital vessels and major nerves
Through IGT-Link port, mixed reality workstation was synchronized with surgical navigation, and surgical planning data were transferred to the mixed reality workstation
Osteotomy lines were marked with the aid of both surgical navigation and mixed reality images visualized through HoloLens
Summary
The oral and maxillofacial region is anatomically complex, housing many vital vessels and major nerves. Because tumors in this region are often deep seated, resection surgery can be challenging. Thorough understanding of the tumor site and margins, individualized surgical planning, and accurate implementation of the surgery are of paramount importance [1]. Recent advances in computer-assisted surgery (CAS), in three-dimensional (3D) reconstruction, virtual surgical planning, and surgical navigation, have greatly improved the safety and accuracy of surgery in the maxillofacial region [2, 3]. Despite continuing improvements in surgical navigation [5], the 3D image display remains two-dimensional, and accurate projection of the images to the surgical field still depends on the surgeon’s experience and imagination [6]
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