Objective: To assess the feasibility and application of mixed reality combined with surgical navigation technology in parapharyngeal space tumor surgery, and to provide a reference for the development and promotion of this technology. Methods: In this study, retrospective data collection was conducted on 16 patients with parapharyngeal space tumors who were treated at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2020 to June 2023. The patient's age was (39.6±17.8) years, with 4 males and 12 females. Mixed reality combined with surgical navigation technology was utilized to assist physicians in the treatment of these patients. Mixed reality combined with surgical navigation technology was used to assist physicians in treatment of these patients. The application steps included acquisition of image data, processing of image data [three-dimensional (3D) reconstruction, image fusion, and virtual surgical design], development of surgical navigation plan, connection of mixed reality and navigation system, automatic registration and intraoperative guidance and validation. In the preoperative plan, landmark points were placed on the virtual tumor and surrounding important structures reconstructed using digital software, serving to guide the localization of crucial anatomical structures. Intraoperative positioning deviation, surgical time, intraoperative blood loss, and postoperative complications were recorded and analyzed to evaluate the clinical application effectiveness of mixed reality combined with surgical navigation technology. Results: With the assistance of mixed reality combined with surgical navigation technology, 16 patients successfully underwent tumor resection. All patients were accurately diagnosed preoperatively by 3D reconstruction and image fusion technology, and a comprehensive preoperative plan was formulated; intraoperatively, mixed reality combined with surgical navigation technology was utilized for the localization of important structures. The average localization deviation of 38 landmark points during the operation were (4.43±1.96) mm, with 62% (26/42) of the points having a deviation of ≥0 and<5 mm. The average duration of the operation was (149.6±53.9) min and the blood loss was 70 (45, 150) ml. The average postoperative follow-up was 16 months, and five patients experienced postoperative complications involving facial paralysis, hoarseness, and choking. Conclusions: Mixed reality combined with surgical navigation technology can achieve the three-dimensional visualization of oral and maxillofacial anatomical structures to achieve precise preoperative diagnosis. During surgery, the technology can real-time display the relationship between soft tissue tumors and the surrounding important anatomical structures, guide surgical operation, and enhance the safety of surgery.
目的： 评估咽旁间隙肿瘤手术中应用混合现实结合手术导航技术的可行性和应用效果，以期为混合现实结合手术导航技术的发展和推广提供参考。 方法： 回顾性收集2020年6月至2023年6月就诊于北京大学口腔医学院·口腔医院口腔颌面外科的16例咽旁间隙肿瘤患者资料，患者年龄（39.6±17.8）岁，男性4例，女性12例。利用混合现实结合手术导航技术辅助医师进行手术治疗，应用步骤包括影像数据获取、影像数据处理（三维重建、图像融合及虚拟手术设计）、手术导航计划制订、混合现实与导航系统连接、自动注册配准和术中引导及验证。术前计划于数字化软件所重建的虚拟肿瘤及周围重要结构上放置标志点，用以引导定位重要解剖结构。分析术中定位偏差、手术时长、术中出血量，随访术后并发症情况，评估混合现实结合手术导航技术的临床应用效果。 结果： 16例患者均于混合现实结合手术导航技术辅助下顺利完成肿瘤切除。所有患者均于术前通过三维重建及图像融合技术实现精确诊断，制订完善的术前规划；术中利用混合现实结合手术导航技术进行重要结构的定位。术中38个标志点定位偏差为（4.43±1.96）mm，偏差≥0且<5 mm的点占比62%（26/42）。手术用时（149.6±53.9）min，出血量70（45，150）ml。术后平均随访16个月，其中5例患者出现术后并发症，包括面瘫、声音嘶哑以及呛咳。 结论： 混合现实结合手术导航技术能实现口腔颌面部解剖结构的立体可视化，实现术前精确诊断；术中实时显示软组织肿瘤与周围重要解剖结构关系，引导手术操作，提升手术安全性。.