With the improvement in computer graphics and sensors, technologies like virtual reality (VR) and augmented reality (AR) have created new possibilities for developing diagnostic and surgical techniques in the field of surgery. VR and AR are the latest technological modalities that have been integrated into clinical practice and medical education, and are rapidly emerging as powerful tools in the field of maxillofacial surgery. In this report, we describe a case of total maxillectomy and orbital floor reconstruction in a patient with malignant fibrous histiocytoma of the maxilla, with preoperative planning via VR simulation and AR-guided surgery. Future developments in VR and AR technologies will increase their utility and effectiveness in the field of surgery.

https://www.mdpi.com/2076-3417/10/18/6288/pdf

Virtual Reality Simulation and Augmented Reality-Guided Surgery for Total Maxillectomy: A Case Report

Objective: Midface reconstruction is challenging for functional and esthetic reasons. The present study analyzed the effect of virtual surgical planning (VSP) of the deep circumflex iliac artery (DCIA) flap for midface reconstruction. Patients and Methods: Thirty-four patients who underwent midface reconstruction with the DCIA flap were included in this retrospective study. Of the 34 patients, 16 underwent preoperative VSP, which used a three-dimensionally printed surgical guide, computer-assisted navigation system, and pre-bent titanium implants to transfer VSP into real-world surgery. The other 18 patients underwent traditional midface reconstruction. The following were compared between the two groups: bony contact rate in the buttress region (BCR), dental arch reconstruction rate (DAR), surgical approach, position of vascular anastomosis, and dental implantation rate. The independent-samples t-test and Fisher’s exact test were used for analysis. P < 0.05 was considered statistically significant. Results: In total, 12 males and 22 females were included in this study. All patients underwent midface reconstruction using the DCIA flap at the same institution. The median age of patients was 33 years (range: 16–68 years). The average BCR and DAR values in the VSP group were 59.4% ± 27.9% and 87.5% ± 18.9%, respectively, which were significantly higher compared with the non-VSP group (P = 0.049 and P = 0.004, respectively). The dental implantation rate in the VSP group (50.0%) was significantly higher compared with the non-VSP group (11.1%; P = 0.023). The intraoral approach for tumor ablation and vascular anastomosis was the most frequent choice in both groups. There was no significant difference between the two groups. All patients were satisfied with facial symmetry postoperatively. Conclusions: VSP could effectively augment the effect of midface reconstruction with the DCIA flap. Stronger bone contact in the buttress region and higher DAR provide more opportunity for dental implantation, which might be the best solution to improve masticatory function in patients with midface defects.

/pdf/virtual-surgical-planning-of-deep-circumflex-iliac-artery-119ugevfwz.pdf

Virtual Surgical Planning of Deep Circumflex Iliac Artery Flap for Midface Reconstruction.

Accurate occlusion-driven maxillary reconstruction with deep circumflex iliac artery flap using computer-assisted techniques and intraoral anastomosis: a case series study.

Background: Reconstruction of the orbital floor after maxillectomy can result in significant functional and aesthetic morbidity. Study Objective: To measure eyelid position, self-reported visual outcomes, and complications in patients undergoing concurrent maxillectomy and reconstruction with a patient-specific orbital reconstruction implant (PSORI). Design Type: Case series. Materials and Methods: Case series including 12 patients who received PSORI for orbital floor reconstruction after tumor extirpation. Primary outcomes gathered were diplopia, ectropion, and wound healing complications. Results: The majority of patients were men (75%) and the mean age was 53.3 years. Ten patients underwent free flap reconstruction with the majority receiving fibula free flaps (n = 6). Median follow-up was 415.5 days. Three patients (25%) experienced long-term complications, including diplopia (n = 1) and hardware extrusion (n = 3). Each of these occurred in the context of total maxillectomy and radiation. This prompted subsequent use of a modified implant design for the final six patients and the preferential use of a midface-degloving approach. These interventions eliminated extrusions in subsequent patients. Conclusion: PSORIs can be used for orbital floor reconstruction following maxillectomy in combination with free tissue transfer. Implant design is critical to reduce complications. The use of a midface degloving approach and a modified low-profile design was associated with a low rate of complications.

The Use of Patient-Specific Orbital Reconstruction Implants During Maxillectomy Reconstruction.

Maxillary reconstructive surgery with fibula free flaps (FFFs) is a challenging procedure for head and neck surgeons. However, virtual surgical planning (VSP) and three‐dimensional (3D) printing technologies have contributed to improved functional and aesthetic outcomes. The objective of this report is to demonstrate VSP/3D application in reconstruction of maxillary defects using the FFF by describing the different configurations available. We reviewed a series of consecutive cases operated at our institution and considered the management strategy of in‐house planning in VSP/3D application.

Evaluation of virtual surgical planning and three‐dimensional configurations for reconstruction of maxillary defects using the fibula free flap

Summary Purpose The present study aimed to evaluate the symmetry of the orbital floor after maxillectomy and orbital floor reconstruction with individual titanium mesh using a computer-assisted navigation system. Patients and methods Nineteen patients who underwent orbital floor reconstruction with individual titanium mesh were included in this study. Postoperative computed tomography scans recorded after three-dimensional (3D) reconstruction were used to evaluate the symmetry of the orbital floor, including orbital floor height, orbital floor eminence, globe projection, orbital volume, and surface deviation. Results The average orbital floor height of the reconstructed and the unaffected side was 37.7 ± 2.3 and 37.8 ± 2.7 mm, respectively (P = .47). The average orbital floor eminence of the reconstructed and the unaffected side was 40.1 ± 5.5 and 39.6 ± 5.3 mm, respectively (P = .17). The average globe projection of the reconstructed and the unaffected side was 15.5 ± 3.2 and 15.3 ± 3.0 mm, respectively (P = .27). The average orbital volume of the reconstructed and the unaffected side was 25.9 ± 4.4 and 26.3 ± 4.4 cm3, respectively (P = .29). Repeatability between the reconstructed and the unaffected side was 88.3% ± 2.6% at within 1 mm and 98.6% ± 0.9% at within 2 mm. The average of maximum deviation was 2.4 ± 0.2 mm. Conclusion Individual titanium mesh is one of the best techniques for orbital floor reconstruction, as it can be placed precisely and helps achieve desirable esthetic outcomes through virtual surgical planning and using a computer-assisted navigation system.

Orbital floor symmetry after maxillectomy and orbital floor reconstruction with individual titanium mesh using computer-assisted navigation.

Objective: To evaluate the feasibility of endoscope-assisted extracapsular resection of benign parotid tumors via temporal and retroauricular approach. Materials and Methods: A total of 12 patients with parotid gland tumors had endoscope-assisted extracapsular resection performed via temporal and retroauricular approach (4 versus 8) between January 2018 and January 2019. Results: All tumors were benign with a median diameter of 2.32 ± 0.49 cm. The mean length of the skin incision was 3.5 ±0.35 cm. The mean operating time 86.7 ± 10.8 minutes. The median blood loss was 30.4 ± 5.94 ml. The median volume of drainage was 27.1 ± 8.88 ml and the duration of drainage was 2 ± 0.71 days. The mean aesthetics scoring assigned by patients was 9.67 ± 0.51. Two patients had numbness of the earlobe and 1 patient developed a transient salivary sialocele. No facial nerve paresis was observed and no tumor recurrence occurred during the follow-up period. Conclusions: The minimally invasive endoscope-assisted extracapsular resection of benign parotid tumors provide both a safe and reliable technique for benign parotid tumors with excellent cosmetic results.

Endoscope-Assisted Extracapsular Resection of Benign Parotid Tumors Via Temporal and Retroauricular Approach

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Orbital floor symmetry after maxillectomy and orbital floor reconstruction with individual titanium mesh using computer-assisted navigation.

Endoscope-Assisted Extracapsular Resection of Benign Parotid Tumors Via Temporal and Retroauricular Approach