Mixed reality combined with surgical navigation versus conventional navigation for resection of oral and...

To evaluate the feasibility and effectiveness of mixed reality combined with surgical navigation for resection of oral and maxillofacial tumors.

Patients with maxillary or mandibular tumors in the oral and maxillofacial region who underwent surgical treatment at Peking University School and Hospital of Stomatology between January 2020 and June 2023 were enrolled in this study. During the preoperative phase, patients in the mixed reality-surgical navigation group (MRSN group) underwent additional image data processing using mixed reality-surgical navigation technology, which enabled intraoperative tumor localization and resection under navigation guidance. The control group underwent conventional virtual surgical planning (VSP) incorporating computer-aided design (CAD) and computer-aided manufacturing (CAM). Tumor resection in the control group was also performed under surgical navigation guidance. Baseline patient characteristics were recorded for both groups. Using a normal vector-based selection method, osteotomy planes were extracted from the preoperative virtual surgical plan and from postoperative computed tomography reconstruction models using digital software for chromatographic analysis. Deviations between planned and actual osteotomy planes were compared between the two groups. All analyses were performed using SPSS 26.0 software (IBM Corp, Armonk, NY, USA), with statistical significance set at P < 0.05.

A total of 38 patients were included, with 19 patients in each group. The mean osteotomy deviation was significantly smaller in the MRSN group than in the control group (1.84 mm vs. 3.07 mm, P < 0.001). Chromatographic analysis showed that 74.84% of osteotomy points in the MRSN group deviated by less than 3 mm, compared with 64.81% in the control group. Subgroup analyses by tumor location (maxillary vs. mandibular) and pathology (benign vs. malignant) demonstrated consistently smaller deviations in the MRSN group. No significant differences in osteotomy accuracy were observed between maxillary and mandibular tumors or between benign and malignant tumors within either group (P > 0.05). During a mean follow-up of 27 months in the MRSN group, five patients experienced complications, including facial paralysis, skin numbness, and titanium mesh exposure; no tumor recurrence or distant metastasis was observed. In the control group, with a mean follow-up of 18.8 months, two patients developed complications (infection and titanium mesh exposure), and three patients experienced tumor recurrence.

The clinical application of mixed reality combined with surgical navigation is feasible for the resection of oral and maxillofacial tumors. Compared with conventional navigation systems, this approach allows more precise localization of osteotomy planes and improves the accuracy of tumor resection.