2025 Poster Presentations
P360: IMPLEMENTING AUGMENTING REALITY IN CRANIOMAXILLOFACIAL RECONSTRUCTIVE SURGERY: AN EARLY INSTITUTIONAL SERIES IN A TRAUMA I CENTER
Paolo Palmisciano; Brandon B Strong; Anuj Patel; Kiarash Shahlaie; Edward Strong; University of California, Davis
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Background: Complex 3-dimensional (3D) anatomy and limited-access surgical approaches make manage?ment of craniomaxillofacial trauma extremely challenging. Intraoperative navigation and imaging have improved surgical accuracy; however, these tools do not provide real time, interactive visualization of the surgical anatomy within the surgical field. Augmented reality (AR) is a promising new tool which allows the surgeon to generate virtual objects (bony anatomy, plates, models, guides) and visualize them within the operative field.
Objective: To present our early institutional experience using AR in craniomaxillofacial trauma reconstructive surgery, identifying how 3D AR overlays may enhance accuracy and surgical outcomes in the future.
Methods: A retrospective chart review identified 10 patients with complex craniomaxillofacial fractures treated utilizing AR. Brainlab navigation software was used for segmentation/mirroring of the preoperative CT data and generation of a virtual surgical plan including cutting guides, patient specific implants, and bony anatomic models to guide reduction. Each plan was developed in collaboration with Xironetic and loaded onto IntraOpVSP software and transferred to the Microsoft HoloLens 2, an AR head-mounted display. Optical landmark registration via individualized AR tracking QR-codes was used to orient each plan to the patient in the operating room. The surgeon then utilized the goggles during critical portions of each procedure to localized bony segments, osteotomies, and hardware placement. Qualitative analysis included assessment of 1) time for registration, 2) registration accuracy, 3) time of use, 4) ease of use, and 5) surgical applicability.
Results: A total of 10 AR-assisted craniomaxillofacial trauma procedures were identified. Patients were predominantly male (7, 87.5%) with a median age of 48 years (range, 25-78). Surgical indications included: orbital fractures (6, 75%), zygomaticomaxillary complex fractures (2, 25%), and revision Lefort fractures and mandibular fractures with malocclusion (2, 25%). Registration took on average 10 minutes (range, 8-15 minutes) per case. Accuracy was qualitatively comparable to traditional navigation, however virtual object drift did occur intermittently, requiring re-registration. The AR goggles were utilized for an average of 20 minutes (range, 15-30 minutes) for each case. Surgeons found them to be lightweight, comfortable, and easy to intermittently wear during surgery. Safety goggles could be worn below the AR goggles, but loupes could not be used. There is currently no capacity to mount a headlight on AR googles. Surgeons found the application most helpful for visualization underling bony anatomy, localization of neurovascular structures, display of cutting guides, and assistance with placement of implants. Excellent bony reduction and functional outcomes were achieved in all cases. In case of bone graft usage, AR plans were also used to accurately plan and intraoperatively achieve bone graft harvesting (Figure 1).
Conclusion: AR goggles show early promise for intraoperative guidance in craniomaxillofacial reconstructive surgery. They provide similar information as traditional navigational, with the advantage of depicting the full virtual surgical plan directly onto the patient’s anatomy.