Mixed Reality in the Reconstruction of Orbital Floor: An Experimental and Clinical Evaluative Study.

Introduction: Orbital floor fractures are common within midface fractures. Their management includes restoration of orbital volume and anatomy. However, these procedures could be associated with the mispositioning of implants and inadequate volume restoration. Nowadays medical rapid prototyping, virtual planning (VP), and navigation systems significantly increase the precision of such procedures. Nevertheless, the application of intraoperative navigation could be associated with intraoperative mistakes related to two-dimensional imaging. The application of mixed reality (MR) could solve this problem. The current study aims to demonstrate the application of MR in orbital reconstruction. Materials and Methods: The current study included experimental and clinical implementation of MR in orbital reconstruction. Within the experimental part, 10 residents and 5 experienced maxillofacial surgeons were added. All data and customised software were well documented and then used in a single clinical case of orbital floor reconstruction. Results: Visual assessment of plate positioning within the experiment revealed proper plate positioning in 8 cases. A comparison of virtual and real measurements showed a stable deviation of 0.65-1.15 (mean 0.9 mm). As a result of the clinical implementation of MR technology, after surgical reconstruction, the patient showed improvement in ocular mobility and reduction of diplopia. A postoperative computed tomography scan showed proper plate positioning. Discussion: Implementation of MR based on VP could significantly improve the results of preoperative planning, intraoperative navigation, and surgery. However, existing technical limitations that relate to navigation principles could produce mistakes and errors. Therefore, further investigations related to the 6 degrees of freedom problem solution are considered reasonable in the elimination of listed issues.