{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:12:30Z","timestamp":1790115150433,"version":"4.0.1"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T00:00:00Z","timestamp":1670803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>In the relevant global context, although virtual reality, augmented reality, and mixed reality have been emerging methodologies for several years, only now have technological and scientific advances made them suitable for revolutionizing clinical care and medical settings through the provision of advanced features and improved healthcare services. Over the past fifteen years, tools and applications using augmented reality (AR) have been designed and tested in the context of various surgical and medical disciplines, including maxillofacial surgery. The purpose of this paper is to show how a marker-less AR guidance system using the Microsoft\u00ae HoloLens 2 can be applied in mandible and maxillary demolition surgery to guide maxillary osteotomies. We describe three mandibular and maxillary oncologic resections performed during 2021 using AR support. In these three patients, we applied a marker-less tracking method based on recognition of the patient\u2019s facial profile. The surgeon, using HoloLens 2 smart glasses, could see the virtual surgical planning superimposed on the patient\u2019s anatomy. We showed that performing osteotomies under AR guidance is feasible and viable, as demonstrated by comparison with osteotomies performed using CAD-CAM cutting guides. This technology has advantages and disadvantages. However, further research is needed to improve the stability and robustness of the marker-less tracking method applied to patient face recognition.<\/jats:p>","DOI":"10.3390\/jpm12122047","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T03:02:37Z","timestamp":1670814157000},"page":"2047","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Application of Augmented Reality to Maxillary Resections: A Three-Dimensional Approach to Maxillofacial Oncologic Surgery"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0987-9184","authenticated-orcid":false,"given":"Francesco","family":"Ceccariglia","sequence":"first","affiliation":[{"name":"Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-1356","authenticated-orcid":false,"given":"Laura","family":"Cercenelli","sequence":"additional","affiliation":[{"name":"eDimes Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9833-9800","authenticated-orcid":false,"given":"Giovanni","family":"Badiali","sequence":"additional","affiliation":[{"name":"Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Marcelli","sequence":"additional","affiliation":[{"name":"eDimes Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5815-7591","authenticated-orcid":false,"given":"Achille","family":"Tarsitano","sequence":"additional","affiliation":[{"name":"Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy"},{"name":"Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.spinee.2021.03.018","article-title":"Augmented and virtual reality in spine surgery, current applications and future potentials","volume":"21","author":"Ghaednia","year":"2021","journal-title":"Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2067","DOI":"10.1002\/rcs.2067","article-title":"Virtual, augmented, and mixed reality applications in orthopedic surgery","volume":"16","author":"Verhey","year":"2020","journal-title":"Int. J. Med. Robot. Comput. Assist. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.soc.2018.08.002","article-title":"Virtual and Augmented Reality in Oncologic Liver Surgery","volume":"28","author":"Quero","year":"2019","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.euf.2020.08.004","article-title":"Real-time Augmented Reality Three-dimensional Guided Robotic Radical Prostatectomy: Preliminary Experience and Evaluation of the Impact on Surgical Planning","volume":"7","author":"Schiavina","year":"2020","journal-title":"Eur. Urol. Focus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1016\/j.clgc.2020.09.005","article-title":"Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience","volume":"19","author":"Schiavina","year":"2021","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.eururo.2021.06.020","article-title":"The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy","volume":"80","author":"Bianchi","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1097\/01.PRS.0000156215.06282.76","article-title":"New Augmented Reality Concepts for Craniofacial Surgical Procedures","volume":"115","author":"Marmulla","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.ijom.2005.05.004","article-title":"An augmented reality system for image-guided surgery","volume":"34","author":"Marmulla","year":"2005","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"59015","DOI":"10.1109\/ACCESS.2020.2973298","article-title":"Review on Augmented Reality in Oral and Cranio-Maxillofacial Surgery: Toward \u201cSurgery-Specific\u201d Head-Up Displays","volume":"8","author":"Badiali","year":"2020","journal-title":"IEEE Access"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.21037\/qims-20-597","article-title":"Mixed reality and three dimensional printed models for resection of maxillary tumor: A case report","volume":"11","author":"Sugahara","year":"2021","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ayoub, A., and Pulijala, Y. (2019). The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery. BMC Oral Health, 19.","DOI":"10.1186\/s12903-019-0937-8"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.kjms.2018.01.009","article-title":"Augmented reality (AR) and virtual reality (VR) applied in dentistry","volume":"34","author":"Huang","year":"2018","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.ijom.2020.09.026","article-title":"Accuracy of Le Fort I osteotomy with combined computer-aided design\/computer-aided manufacturing technology and mixed reality","volume":"50","author":"Koyachi","year":"2021","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/s00464-012-2457-3","article-title":"Surgeons blinded by enhanced navigation: The effect of augmented reality on attention","volume":"27","author":"Dixon","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_15","first-page":"e2510","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_16","doi-asserted-by":"crossref","unstructured":"Battaglia, S., Ratti, S., Manzoli, L., Marchetti, C., Cercenelli, L., Marcelli, E., Tarsitano, A., and Ruggeri, A. (2020). Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap. J. Clin. Med., 9.","DOI":"10.3390\/jcm9072211"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Condino, S., Fida, B., Carbone, M., Cercenelli, L., Badiali, G., Ferrari, V., and Cutolo, F. (2020). Wearable Augmented Reality Platform for Aiding Complex 3D Trajectory Tracing. Sensors, 20.","DOI":"10.3390\/s20061612"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"804748","DOI":"10.3389\/fonc.2021.804748","article-title":"Augmented Reality to Assist Skin Paddle Harvesting in Osteomyocutaneous Fibular Flap Reconstructive Surgery: A Pilot Evaluation on a 3D-Printed Leg Phantom","volume":"11","author":"Cercenelli","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/(SICI)1097-0347(200001)22:1<17::AID-HED4>3.0.CO;2-2","article-title":"A modified classification for the maxillectomy defect","volume":"22","author":"Brown","year":"1999","journal-title":"Head Neck"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"873","DOI":"10.6004\/jnccn.2020.0031","article-title":"Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology","volume":"18","author":"Pfister","year":"2020","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1097\/SCS.0b013e31824cd433","article-title":"Two- and Three-Dimensional Models for the Visualization of Jaw Tumors Based on CT\u2013MRI Image Fusion","volume":"23","author":"Dai","year":"2012","journal-title":"J. Craniofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1007\/s11548-015-1193-2","article-title":"Multicenter study on the use of patient-specific CAD\/CAM reconstruction plates for mandibular reconstruction","volume":"10","author":"Wilde","year":"2015","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/j.jcms.2016.08.014","article-title":"Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap: Role of computer-assisted techniques","volume":"44","author":"Zhang","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1002\/lary.23729","article-title":"Utilization of computed tomography image-guided navigation in orbit fracture repair","volume":"123","author":"Andrews","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2065.e1","DOI":"10.1016\/j.joms.2015.06.171","article-title":"Outcomes of Orbital Floor Reconstruction After Extensive Maxillectomy Using the Computer-Assisted Fabricated Individual Titanium Mesh Technique","volume":"73","author":"Zhang","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"8851964","DOI":"10.1155\/2020\/8851964","article-title":"Experimental Setup Employed in the Operating Room Based on Virtual and Mixed Reality: Analysis of Pros and Cons in Open Abdomen Surgery","volume":"2020","author":"Galati","year":"2020","journal-title":"J. Healthc. Eng."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1109\/JPROC.2019.2956422","article-title":"Biomedical Imaging and Analysis in the Age of Big Data and Deep Learning","volume":"108","author":"Duncan","year":"2020","journal-title":"Proc. IEEE"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1080\/17453674.2018.1506974","article-title":"Surgery guided by mixed reality: Presentation of a proof of concept","volume":"89","author":"Gregory","year":"2018","journal-title":"Acta Orthop."},{"key":"ref_30","first-page":"575","article-title":"A first attempt of inferior vena cava filter successfully guided by a mixed-reality system: A case report","volume":"16","author":"Zhu","year":"2019","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/PRS.0000000000005215","article-title":"Effective Application of Mixed Reality Device HoloLens: Simple Manual Alignment of Surgical Field and Holograms","volume":"143","author":"Mitsuno","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/SLA.0000000000002448","article-title":"Mixed Reality in Visceral Surgery","volume":"266","author":"Sauer","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Piramide, C., Ulrich, L., Piazzolla, P., and Vezzetti, E. (2022). Toward Supporting Maxillo-Facial Surgical Guides Positioning with Mixed Reality\u2014A Preliminary Study. Appl. Sci., 12.","DOI":"10.3390\/app12168154"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1016\/j.jcms.2014.09.001","article-title":"Augmented reality as an aid in maxillofacial surgery: Validation of a wearable system allowing maxillary repositioning","volume":"42","author":"Badiali","year":"2014","journal-title":"J. Cranio-Maxillofac. Surg."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/12\/2047\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:39:29Z","timestamp":1760146769000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/12\/2047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,12]]},"references-count":34,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jpm12122047"],"URL":"https:\/\/doi.org\/10.3390\/jpm12122047","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,12]]}}}