{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:44:25Z","timestamp":1784594665647,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The craniofacial skeleton is a complex three-dimensional structure, and major reconstructive cases remain challenging. We describe a synergistic approach combining intra-operative navigation, three-dimensionally (3D) printed skull models, and mixed reality (MR) to improve predictability in surgical outcomes. A patient with previously repaired bilateral cleft lip and palate, significant midfacial retrusion, and a large maxillary alveolar gap underwent segmental Le Fort I osteotomy and advancement. Preoperative virtual planning was performed, and reference templates were uploaded onto MR glasses. Intra-operatively, the MR glasses projected the templates as holograms onto the patient\u2019s skull, guiding osteotomy line marking and validating bony segment movement, which was confirmed with conventional navigation. The 3D-printed skull model facilitated dissection and removal of intervening bony spicules. Preoperative planning proceeded seamlessly across software platforms. Osteotomy lines marked with MR showed good concordance with conventional navigation, and final segment positioning was accurately validated. Postoperative outcomes were satisfactory, with re-established occlusion and closure of the maxillary alveolar gap. The combined use of conventional navigation, 3D-printed models, and MR is feasible and allows safe integration of MR into complex craniofacial reconstruction while further validation of the technology is ongoing.<\/jats:p>","DOI":"10.3390\/bioengineering13010010","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T10:57:18Z","timestamp":1766487438000},"page":"10","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Synergistic Triad of Mixed Reality, 3D Printing, and Navigation in Complex Craniomaxillofacial Reconstruction"],"prefix":"10.3390","volume":"13","author":[{"given":"Elijah Zhengyang","family":"Cai","sequence":"first","affiliation":[{"name":"Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry Ho Man","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Gao","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore"},{"name":"Artificial intelligence Office, National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5676-2520","authenticated-orcid":false,"given":"Kee Yuan","family":"Ngiam","sequence":"additional","affiliation":[{"name":"Artificial intelligence Office, National University Health System, Singapore 119074, Singapore"},{"name":"Division of Thyroid and Endocrine Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore"},{"name":"Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4682-2951","authenticated-orcid":false,"given":"Catherine Tong How","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiam Chye","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"ref_1","unstructured":"Anderson, B.W., Kortz, M.W., and Al Kharazi, K. 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