Supporting mandibular resection with intraoperative navigation utilizing augmented reality technology - A proof of concept study

Objective: The aim of this study was to compare the accuracy of simulated mandibular osteotomies performed with cutting guides and two different intraoperative navigation systems based on simple (sAR) and navigated (nAR) augmented reality technology. Material and methods: A total of 126 osteotomies were performed on 21 identical mandible models according to a prespecified virtual surgery plan. The data from postoperative computed tomography (CT) images were fused with preoperative CT scans to objectively compare the outcomes, i.e. angular deviations from the osteotomy trajectory (degrees) and displacement of two control points (mm). Results: Osteotomies performed with cutting guides turned out to be the most accurate, with mean angular deviation of 4.94 +/- 4.62 degrees and mean control point displacement of 1.65 +/- 0.88 mm. Mandibular osteotomies assisted with sAR and nAR were less accurate in terms of mean angular deviations (5.34 +/- 3.67 degrees and 7.14 +/- 5.19 degrees, respectively) and control point displacements (1.79 +/- 0.94 mm and 2.41 +/- 1.34 mm, respectively). Conclusion: Our findings imply that in future, AR-based intraoperative navigation systems may find application in everyday clinical practice. Although AR technology still requires some improvements, it can already be used for presentation of digital navigation data, enhancing surgeon's awareness and handeye coordination during mandibular resection and reconstruction procedures. (c) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.