{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:58:25Z","timestamp":1792267105755,"version":"4.4.0"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Craniofacial deformities, particularly craniosynostosis, present significant surgical challenges due to complex anatomy and the need for individualised, high-precision interventions. Augmented reality (AR) has emerged as a promising tool in craniofacial surgery, offering enhanced spatial visualisation, real-time anatomical referencing, and improved surgical accuracy. This review explores the current and emerging applications of AR in preoperative planning, intraoperative navigation, and surgical education within paediatric craniofacial surgery. Through a literature review of peer-reviewed studies, we examine how AR platforms, such as the VOSTARS system and Microsoft HoloLens, facilitate virtual simulations, precise osteotomies, and collaborative remote guidance. Despite demonstrated benefits in feasibility and accuracy, widespread clinical adoption is limited by technical, ergonomic, financial, and training-related challenges. Future directions include the integration of artificial intelligence, haptic feedback, and robotic assistance to further augment surgical precision and training efficacy. AR holds transformative potential for improving outcomes and efficiency in craniofacial deformity correction, warranting continued research and clinical validation.<\/jats:p>","DOI":"10.3390\/jcm14124359","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T06:11:07Z","timestamp":1750313467000},"page":"4359","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Augmented Reality Integration in Surgery for Craniosynostoses: Advancing Precision in the Management of Craniofacial Deformities"],"prefix":"10.3390","volume":"14","author":[{"given":"Divya","family":"Sharma","sequence":"first","affiliation":[{"name":"University Hospitals Bristol & Weston, Bristol, BS2 8HW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9137-5291","authenticated-orcid":false,"given":"Adam Matthew","family":"Holden","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol & Weston, Bristol, BS2 8HW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soudeh","family":"Nezamivand-Chegini","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol & Weston, Bristol, BS2 8HW, UK"},{"name":"Department of Oral & Maxillofacial Surgery, Honorary Clinical Lecturer for University College London, London WC1E 6B5, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kaplan, N., Marques, M., Scharf, I., Yang, K., Alkureishi, L., Purnell, C., Patel, P., and Zhao, L. (2023). Virtual Reality and Augmented Reality in Plastic and Craniomaxillofacial Surgery: A Scoping Review. Bioengineering, 10.","DOI":"10.3390\/bioengineering10040480"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.jcms.2006.07.862","article-title":"Application of an Augmented Reality Tool for Maxillary Positioning in Orthognathic Surgery\u2014A Feasibility Study","volume":"34","author":"Mischkowski","year":"2006","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_3","unstructured":"Maria, B., Achille, P., Co-Supervisori, T., Marcelli, E., and Cercenelli, L. (2024). Application of Augmented Reality in Craniofacial Surgery: A Feasibility Study, University of Bologna."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cercenelli, L., Carbone, M., Condino, S., Cutolo, F., Marcelli, E., Tarsitano, A., Marchetti, C., Ferrari, V., and Badiali, G. (2020). The Wearable VOSTARS System for Augmented Reality-Guided Surgery: Preclinical Phantom Evaluation for High-Precision Maxillofacial Tasks. J. Clin. Med., 9.","DOI":"10.3390\/jcm9113562"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e5524","DOI":"10.1097\/GOX.0000000000005524","article-title":"The Role of Virtual Surgical Planning in Surgery for Complex Craniosynostosis","volume":"12","author":"Imahiyerobo","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.bjoms.2022.08.007","article-title":"Systematic Review of Techniques Used to Validate the Registration of Augmented-Reality Images Using a Head-Mounted Device to Navigate Surgery","volume":"61","author":"Chegini","year":"2023","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"102361","DOI":"10.1016\/j.media.2022.102361","article-title":"Utility of Optical See-through Head Mounted Displays in Augmented Reality-Assisted Surgery: A Systematic Review","volume":"77","author":"Birlo","year":"2022","journal-title":"Med. Image Anal."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101318","DOI":"10.1016\/j.jormas.2022.10.017","article-title":"Augmented Reality Guided in Reconstruction of Mandibular Defect with Fibular Flap: A Cadaver Study","volume":"124","author":"Zhao","year":"2023","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1109\/TMRB.2019.2957061","article-title":"A Review of Augmented Reality in Robotic-Assisted Surgery","volume":"2","author":"Qian","year":"2020","journal-title":"IEEE Trans. Med. Robot. Bionics"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Tokg\u00f6z, E., and Carro, M.A. (2023). Robotics Applications in Facial Plastic Surgeries. Cosmetic and Reconstructive Facial Plastic Surgery, Springer Nature.","DOI":"10.1007\/978-3-031-31168-0"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jcms.2019.04.008","article-title":"A New Method for Cranial Vault Reconstruction: Augmented Reality in Synostotic Plagiocephaly Surgery","volume":"47","author":"Han","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1007\/s11548-022-02634-y","article-title":"Augmented Reality Navigation for Minimally Invasive Craniosynostosis Surgery: A Phantom Study","volume":"17","author":"Thabit","year":"2022","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_13","unstructured":"Mato, D.G., and Pascau Gonz\u00e1lez-Garz\u00f3n, J. (2021). Optimization of Craniosynostosis Surgery: Virtual Planning, Intraoperative 3D Photography and Surgical Navigation, Universidad Carlos III de Madrid."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3877","DOI":"10.1016\/j.bjps.2022.08.072","article-title":"Practical Use of Augmented Reality for Posterior Distraction in Craniosynostosis","volume":"75","author":"Sakamoto","year":"2022","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1186\/s13018-020-02066-x","article-title":"Augmented Reality-Guided Periacetabular Osteotomy\u2014Proof of Concept","volume":"15","author":"Kiarostami","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2038","DOI":"10.1097\/GOX.0000000000002038","article-title":"Virtual Surgical Planning Decreases Operative Time for Isolated Single Suture and Multi-Suture Craniosynostosis Repair","volume":"6","author":"Andrew","year":"2018","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E19","DOI":"10.3171\/2019.12.FOCUS19854","article-title":"Augmented Reality and Physical Hybrid Model Simulation for Preoperative Planning of Metopic Craniosynostosis Surgery","volume":"48","author":"Coelho","year":"2020","journal-title":"Neurosurg. Focus."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/01.GOX.0000584440.04703.7e","article-title":"Holographic Surgical Planning and Telementoring for Craniofacial Surgery","volume":"7","author":"Cho","year":"2019","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/SCS.0000000000008134","article-title":"Caregiver Preferences for Three-Dimensional Printed or Augmented Reality Craniosynostosis Skull Models: A Cross-Sectional Survey","volume":"33","author":"Chen","year":"2022","journal-title":"J. Craniofacial Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.jcms.2019.04.005","article-title":"A Feasibility Study of a New Method to Enhance the Augmented Reality Navigation Effect in Mandibular Angle Split Osteotomy","volume":"47","author":"Gao","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/j.bjps.2018.03.018","article-title":"Does Intraoperative Navigation Improve the Accuracy of Mandibular Angle Osteotomy: Comparison between Augmented Reality Navigation, Individualised Templates and Free-Hand Techniques","volume":"71","author":"Zhu","year":"2018","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1302\/2046-3758.63.BJR-2016-0289.R1","article-title":"Augmented Reality in Bone Tumour Resection","volume":"6","author":"Cho","year":"2017","journal-title":"Bone Jt. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1007\/s00464-017-5791-7","article-title":"Augmented Reality in a Tumor Resection Model","volume":"32","author":"Chauvet","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1016\/j.joms.2010.06.177","article-title":"The Accuracy of Virtual Surgical Planning in Free Fibula Mandibular Reconstruction: Comparison of Planned and Final Results","volume":"68","author":"Roser","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_25","first-page":"e6256","article-title":"Virtual Surgical Planning Computer-Aided Design-Guided Osteocutaneous Fibular Free Flap for Craniofacial Reconstruction: A Novel Surgical Approach","volume":"11","author":"Davey","year":"2019","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1002\/lary.23717","article-title":"Computer-assisted Design and Rapid Prototype Modeling in Microvascular Mandible Reconstruction","volume":"123","author":"Hanasono","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1002\/lary.28090","article-title":"Supporting Fibula Free Flap Harvest with Augmented Reality: A Proof-of-concept Study","volume":"130","author":"Pietruski","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1016\/j.jormas.2021.01.005","article-title":"Feasibility of the Application of Mixed Reality in Mandible Reconstruction with Fibula Flap: A Cadaveric Specimen Study","volume":"122","author":"Meng","year":"2021","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2510","DOI":"10.1097\/GOX.0000000000002510","article-title":"Combination of CAD\/CAM and Augmented Reality in Free Fibula Bone Harvest","volume":"7","author":"Battaglia","year":"2019","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1097\/AS9.0000000000000275","article-title":"A training tool for clinicians in segmenting medical images to make 3D models","volume":"4","author":"Chegini","year":"2023","journal-title":"Ann. Surg. Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"179","DOI":"10.5999\/aps.2017.44.3.179","article-title":"Virtual Reality and Augmented Reality in Plastic Surgery: A Review","volume":"44","author":"Kim","year":"2017","journal-title":"Arch. Plast. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e35899","DOI":"10.1016\/j.heliyon.2024.e35899","article-title":"Effect of Prolonged Wear and Frame Tightness of AR Glasses on Comfort","volume":"10","author":"Du","year":"2024","journal-title":"Heliyon"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"454","DOI":"10.21037\/atm.2016.12.23","article-title":"Augmented and Virtual Reality in Surgery\u2014The Digital Surgical Environment: Applications, Limitations and Legal Pitfalls","volume":"4","author":"Khor","year":"2016","journal-title":"Ann. Transl. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ma, L., Huang, T., Wang, J., and Liao, H. (2023). Visualization, Registration and Tracking Techniques for Augmented Reality Guided Surgery: A Review. Phys. Med. Biol., 68.","DOI":"10.1088\/1361-6560\/acaf23"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4359\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:54:41Z","timestamp":1760032481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":34,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14124359"],"URL":"https:\/\/doi.org\/10.3390\/jcm14124359","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]}}}