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Combining Virtual Surgical Planning and Mixed-Reality for Verification of Bony Alignment in Orthognathic Surgery
Nicolas Kass
1, Anjali Raghuram
1, Angel Dixon
1, Sumaarg Pandya
1, Megan Pencek
1, Nikhil Sharma
2, Stephen Canton
3, Edward Andrews
2, Jesse Goldstein
1
1Department of Plastic Surgery, University of Pittsburgh Medical Center, USA; 2Department of Neurological Surgery, UPMC, USA; 3Department of Orthopaedic Surgery, UPMC, USA
Background
Virtual surgical planning (VSP) gives a surgeon a roadmap of the operation prior to the start of the case and Mixed Reality (MR) allows for superimposed visualization and manipulation of patient imaging intraoperatively. We evaluated a workflow for incorporating VSP and MR to better understand complex patient anatomy in orthognathic surgery and compare intraoperative results with an idealized version.
Methods
VSP was done in mimics for Le Fort I osteotomy, BSSO, and genioplasty in a pediatric patient. Medivis SurgicalAR and Microsoft Hololens2 were used to visualize preoperative patient CT imaging during the start of the case and VSP to verify bony alignment. Deviation from real patient anatomy was assessed in multiple methods of registration and ease of workflow was assessed.
Results
Virtual surgical planning was carried out multiple weeks preoperatively. Initial registration on bilateral medial and lateral canthi lasted 8 minutes and 43 seconds and was significantly different than patient anatomy. Second registration with a fifth point over the frontal bone lasted 4 minutes and 47 seconds. Registration with a sixth point over the naision lasted 1 minute 30 seconds and was most accurate. The hologram was highly sensitive to manipulation of tracking fiducial array.
Discussion
We found that increasing the number of virtual fiducials in multiple axes increased registration accuracy and that superimposing VSP imaging is a viable method of verification of intraoperative efficacy. This is the first intraoperative demonstration of the viability of combining preoperative CT for guidance and VSP for confirmation of desired postoperative anatomic changes.
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