Immersive augmented reality-guided craniofacial surgical navigation: system architecture and feasibility study

Abstract This study aimed to design a noninvasive augmented reality (AR) navigation system for craniofacial surgery based on a head-mounted display (HMD). The system enables accurate localization through noninvasive registration and rapid intraoperative re-registration, with the goal of enhancing patient safety simplify surgical navigation. Its clinical feasibility was preliminarily evaluated in representative surgical scenarios. In this study, a noninvasive AR navigation system for craniofacial surgery was developed based on a HMD integrated with real-time optical tracking. Two custom 3D-printed tools were designed to enable accurate registration and facilitate rapid intraoperative realignment when positional drift occurs. Patients undergoing oral surgery were prospectively enrolled, and preoperative CBCT data were used for 3D reconstruction. Two surgeons (Doctor A and Doctor B) independently completed preoperative localization to evaluate accuracy and reproducibility. Intraoperative validation was subsequently performed by Doctor A, who served as the operating surgeon. The AR navigation system operated smoothly throughout the study, which included a total of 41 patients. The mean time required for preoperative 3D reconstruction was 8.61 (7.72–9.41) min. For preoperative localization, two doctors required 2.25 ± 0.72 min and 2.20 ± 0.70 min, respectively ( p = 0.35), with localization errors of 1.57 ± 0.78 mm and 1.53 ± 0.98 mm ( p = 0.59); no statistically significant differences were observed. The intraoperative localization time was 2.58 ± 0.64 min, significantly longer than the preoperative measurement ( p = 0.03), and the intraoperative localization error increased to 1.95 ± 0.83 mm ( p = 0.007). Preliminary results demonstrate that AR-based navigation can achieve millimeter-level accuracy in craniofacial surgery, improving intraoperative intuitiveness and safety. This noninvasive system shows potential as an efficient and feasible alternative to conventional navigation methods.