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An Initial Demonstration of Mixed Reality-Guided Percutaneous Screw Placement in Mandible Angle Fractures
Nicolás M. Kass, Kelly Daniels, Anthony Tang, Sumaarg Pandya, Malke Asaad, Stephen Canton, Nikhil Sharma, Edward Andrews, Jesse Goldstein, Mario Solari
University of Pittsburgh Medical Center
2024-01-15
Presenter: Nicolás M Kass
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background
Mandibular angle fractures have high rates of complications due, in part, to impaired visibility. Mixed Reality (MR) allows surgeons to display holographic renderings of patient CT scans and plan drilling trajectories directly on top of a patient. We demonstrate a method of planning trajectories and guiding screw placement by using MR to visualize the entire skull, including the mandible, prior to an incision.
Methods
Two metal targets were fixed to the mandible of a cadaver and a CT was obtained. The CT was uploaded and projected using the Medivis SurgicalAR system and Microsoft HoloLens 2. Virtual target and entry points were placed on the hologram, creating two trajectory lines perpendicular to the mandible. Drilling was performed according to feedback on depth and angulation of the drill from the MR system.
Results
Time to plot trajectories, place fiducials, and match the hologram to the cadaver was 4 minutes 53 seconds. Time to locate correct trajectories and drill screw guide holes was 5 minutes and 13 seconds. On assessment of the drilling accuracy, eight guide holes were drilled with mean deviation from intended location of 1.67mm and angle deviation of 2.8° ± 2.7°.
Discussion
We found that MR guided trajectory planning led to a high level of precision in percutaneous screw placement with minimal potential increase in operating time. This technology can reduce complication rates and reduce operating time in mandible angle fractures. Immediate future directions include a comparison with standard of care on more cadavers.
