Jiang Dongwen, Wang Shuang, Ma Chenhao, Yang Jinxiu, He Leren
From the Department of Auricular Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Plastic & Reconstructive Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China.
Ann Plast Surg. 2025 Jan 1;94(1):e11-e20. doi: 10.1097/SAP.0000000000004043. Epub 2024 Aug 20.
An ideal 3D cartilage framework and accurate anatomical location are the most important factors to carry out a satisfactory reconstruction of the ear. To streamline this process, we developed an augmented reality assistance system, HoloLens Ear Image Guidance, which is based on computed tomography (CT) data, tailor-made navigation kits to guide reconstruction, data processing software, and HoloLens hardware. The objective of this study is to verify its feasibility in a clinical setting.
This study first validated our system in healthy controls and then extrapolated data to test on patients with microtia. First, three healthy volunteers were recruited, and reconstructive navigation kits were made using 3D printing. CT data were collected for the head and neck and imported into the HoloLens Ear Image Guidance Application to generate a personalized 3D virtual ear image. Volunteers then wore the navigation kits while researchers observed them through the HoloLens to check accuracy, track delay, and view the ear image guide.Ten patients with unilateral microtia were recruited and CT data were collected, and reconstructive navigation kits were made to assist with surgery. The procedure was monitored to record the surgeon's experience wearing the HoloLens, the patients' complications associated with wearing navigation kit, and to measure the symmetry between the reconstructed ear and the reference counterpart.
In control patients, the deviation between the virtual image and the real ear was less than 2.4% (±0.22%); the tracking delay was less than 1.26 s (±0.09 s), the display effect was good, and surgeons did not report discomfort or dizziness while wearing the HoloLens. Volunteers did not report any pain from holding the navigation reference in their mouth during the test. Following validation, the HoloLens-assisted procedures were not associated with surgeon discomfort or dizziness. No complications were noted in patients including injury to the oral mucosa. Symmetry between the reconstructed ear and the contralateral ear was noted to be satisfactory in HoloLens-assisted surgery.
The HoloLens Ear Image Guidance initially met clinical demands in registration accuracy, tracking speed, and subjective user experience, which can be used as the basis for continual software improvements and clinical application.
理想的三维软骨框架和精确的解剖位置是实现满意耳部重建的最重要因素。为简化这一过程，我们开发了一种增强现实辅助系统——HoloLens耳部图像引导系统，该系统基于计算机断层扫描（CT）数据、定制的导航套件以指导重建、数据处理软件和HoloLens硬件。本研究的目的是验证其在临床环境中的可行性。
本研究首先在健康对照者中验证我们的系统，然后将数据外推至小耳畸形患者进行测试。首先，招募了三名健康志愿者，使用3D打印制作重建导航套件。收集头颈部的CT数据并导入HoloLens耳部图像引导应用程序以生成个性化的三维虚拟耳部图像。志愿者佩戴导航套件时，研究人员通过HoloLens观察他们，以检查准确性、跟踪延迟并查看耳部图像引导。招募了10名单侧小耳畸形患者，收集CT数据，并制作重建导航套件以辅助手术。监测该过程以记录外科医生佩戴HoloLens的体验、患者佩戴导航套件相关的并发症，并测量重建耳与对照耳之间的对称性。
在对照患者中，虚拟图像与真实耳朵之间的偏差小于2.4%（±0.22%）；跟踪延迟小于1.26秒（±0.09秒），显示效果良好，外科医生佩戴HoloLens时未报告不适或头晕。志愿者在测试过程中未报告因将导航参考物含在口中而产生任何疼痛。验证后，HoloLens辅助手术过程未导致外科医生不适或头晕。患者未出现包括口腔黏膜损伤在内的并发症。在HoloLens辅助手术中，重建耳与对侧耳之间的对称性令人满意。
HoloLens耳部图像引导系统在配准精度、跟踪速度和主观用户体验方面初步满足了临床需求，可作为软件持续改进和临床应用的基础。
