Background: Mandibular reconstruction with autologous bone is a challenging procedure that has benefited from the use of 3D printed cutting guides. However, guides present challenges including long preparatory times, high equipment costs and often imperfect alignment to bone. Recent developments in augmented/mixed reality technology may offer an alternative to address these challenges. Methods: This systematic review aimed to assess current applications and feasibility of augmented/mixed reality technology in mandibular reconstructive surgery, in both preclinical and clinical settings. Following extensive screening, 16 articles were included and appraised for workflow and accuracy, as well as user experience, complications, time and procedural costs. Results: Five different systems were described. They were most applied in mandible exposure and resection, donor bone exposure, dissection and osteotomy. Other novel applications were described, including displaying virtual relevant anatomy intraoperatively and assisting in perforator mapping. Accuracy was assessed in 10 studies via six different measures and reporting was highly variable. Of those studies concerned with measuring accuracy of osteotomy, 3D printed guides showed a statistically significant reduction in angular deviation versus the augmented/mixed reality group in at least one plane. Osteotomy plane distance showed mixed results and flap volume was comparable between groups. User experience, specifically surrounding functionality, useability and ergonomics, was varied and no adverse complications were reported. Procedure cost and time were under-investigated across studies. Conclusion: The literature describes interesting emerging applications for augmented/mixed reality in mandibular reconstruction, however further research is required to explore its feasibility as a potential alternative adjunct.
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