Artificial Intelligence-Assisted Soft-Tissue Virtual Planning in Computer-Assisted Jaw Reconstruction with Fibula Free Flaps

Computer-assisted surgery has transformed jaw reconstruction, enabling 1-stage functional reconstruction with fibula bone segmentation and dental implantation. However, virtual surgical planning without consideration of perforator position and soft tissue can lead to a difficult flap inset. Despite the rapid development of bony planning in recent years, little progress has been made in planning soft tissue, which limits the predictable execution of the plan. An artificial intelligence (AI)-enabled automatic program for segmenting skin perforating vessels was developed. The models of skin perforating vessels were incorporated into the virtual surgical planning workflow when designing osteotomy and dental implantation sites. During the surgery, the vessel models were automatically registered and projected onto the skin of the patient for goggle-free augmented reality-guided flap design and harvest. Consecutive patients undergoing fibula free flap reconstructions participated in this pilot study. The perforators identified by the AI program and those identified during surgery were compared. Seventy-nine skin perforators in 26 consecutive patients were mapped out using the AI program and incorporated into the routine virtual surgical planning workflow. No intraoperative adjustments to the plan were required due to the perforator location. The overall predictive accuracy of the skin perforator segmentation was 92.8%. For the first time, this study used a combined AI and augmented reality approach for preoperative planning and intraoperative execution of the soft-tissue component in computer-assisted jaw reconstruction, demonstrating promising outcomes. This study demonstrated the potential of AI and augmented reality to improve the predictability of functional jaw reconstruction.