Mandibular resection and defect reconstruction guided by a contour registration-based augmented reality system: A preclinical trial.

The aim of this study was to verify the feasibility and accuracy of a contour registration-based augmented reality (AR) system in jaw surgery. An AR system was developed to display the interaction between virtual planning and images of the surgical site in real time. Several trials were performed with the guidance of the AR system and the surgical guide. The postoperative cone beam CT (CBCT) data were matched with the preoperatively planned data to evaluate the accuracy of the system by comparing the deviations in distance and angle. All procedures were performed successfully. In nine model trials, distance and angular deviations for the mandible, reconstructed fibula, and fixation screws were 1.62 +/- 0.38 mm, 1.86 +/- 0.43 mm, 1.67 +/- 0.70 mm, and 3.68 +/- 0.71 degrees , 5.48 +/- 2.06 degrees , 7.50 +/- 1.39 degrees , respectively. In twelve animal trials, results of the AR system were compared with the surgical guide. Distance deviations for the bilateral condylar outer poles were 0.93 +/- 0.63 mm and 0.81 +/- 0.30 mm, respectively (p = 0.68). Distance deviations for the bilateral mandibular posterior angles were 2.01 +/- 2.49 mm and 2.89 +/- 1.83 mm, respectively (p = 0.50). Distance and angular deviations for the mandible were 1.41 +/- 0.61 mm, 1.21 +/- 0.18 mm (p = 0.45), and 6.81 +/- 2.21 degrees , 6.11 +/- 2.93 degrees (p = 0.65), respectively. Distance and angular deviations for the reconstructed tibiofibular bones were 0.88 +/- 0.22 mm, 0.84 +/- 0.18 mm (p = 0.70), and 6.47 +/- 3.03 degrees , 6.90 +/- 4.01 degrees (p = 0.84), respectively. This study proposed a contour registration-based AR system to assist surgeons in intuitively observing the surgical plan intraoperatively. The trial results indicated that this system had similar accuracy to the surgical guide.