Direct visualization of intraparotid facial nerve assisting in parotid tumor resection.

Precise recognition of the intraparotid facial nerve (IFN) is crucial during parotid tumor resection. We aimed to explore the application effect of direct visualization of the IFN in parotid tumor resection. Fifteen patients with parotid tumors were enrolled in this study and underwent specific radiological scanning in which the IFNs were displayed as high-intensity images. After image segmentation, IFN could be preoperatively directly visualized. Mixed reality combined with surgical navigation were applied to intraoperatively directly visualize the segmentation results as real-time three-dimensional holograms, guiding the surgeons in IFN dissection and tumor resection. Radiological visibility of the IFN, accuracy of image segmentation and postoperative facial nerve function were analyzed. The trunks of IFN were directly visible in radiological images for all patients. Of 37 landmark points on the IFN, 36 were accurately segmented. Four patients were classified as House-Brackmann Grade I postoperatively. Two patients with malignancies had postoperative long-standing facial paralysis. Direct visualization of IFN was a feasible novel method with high accuracy that could assist in recognition of IFN and therefore potentially improve the treatment outcome of parotid tumor resection.

Mixed Reality Combined with Surgical Navigation in Resection of Micro- and Mini-Tumors of the Parotid Gland: A Pilot Study.

OBJECTIVE: This study aimed to evaluate the feasibility and outcomes of mixed reality combined with surgical navigation (MRSN) in the resection of parotid micro- and mini-tumors. METHODS: Eighteen patients who underwent parotid tumor resection between December 2020 and November 2022 were included. Six patients were enrolled in MRSN group, and the surgeons performed the surgery with the help of MRSN technology. The surgical procedures include virtual planning, data transfer between mixed reality and surgical navigation, tumor localization and resection assisted by surgical navigation under mixed reality environment. Twelve patients were enrolled in control group, and intraoperative tumor localization and resection were performed according to the experience of the surgeon. Total surgery time and intraoperative bleeding were recorded. Perioperative complications were recorded during follow-up. RESULTS: The mean surgery time of MRSN group (76.7 ± 14.0 min) and control group (65.4 ± 21.3 min) showed no significant difference (p = 0.220), so did the intraoperative bleeding of MRSN group (16.0 ± 8.0 mL) and control group (16.7 ± 6.6 mL) (p = 0.825). None of the patient in MRSN group underwent any complication, although one patient in control group suffered temporary facial paralysis. The mean deviation between the virtually marked and the intraoperative actual outermost point of tumor was 3.03 ± 0.83 mm. CONCLUSION: MRSN technology can realize real-time three-dimensional visualization of the tumor, and it has the potential of enhancing the safety and accuracy of resection of micro- and mini-tumors of parotid gland. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1670-1678, 2024.

Head and neck carcinoma in children: A clinicopathological study of 42 cases.

Background/purpose: Cancer is an important part of the global burden of childhood diseases. Head and neck carcinoma in children is rare and related research is limited. This study aimed to investigate the clinicopathological features of childhood head and neck carcinoma. Materials and methods: Forty-two cases of childhood head and neck carcinoma treated in our institution were reviewed and analyzed. Results: Median age overall was 11 years. Twenty-three patients (54.8%) were male and 19 (45.2%) were female. Parotid gland location was most common (54.8%). Mucoepidermoid carcinoma and squamous cell carcinoma were the most common histological types (57.1% and 11.9%, respectively). Two patients had a history of bone marrow transplantation and two had a history of odontogenic keratocyst. The recurrence rate after treatment was 8.6%. Conclusion: Early diagnosis and treatment and close follow-up of childhood head and neck carcinoma are warranted to prevent recurrence and improve clinical outcome.

Accuracy of Mixed Reality Combined With Surgical Navigation Assisted Oral and Maxillofacial Tumor Resection.

OBJECTIVE: To evaluate the feasibility and accuracy of mixed reality combined with surgical navigation in oral and maxillofacial tumor surgery. METHODS: Retrospective analysis of data of seven patients with oral and maxillofacial tumors who underwent surgery between January 2019 and January 2021 using a combination of mixed reality and surgical navigation. Virtual surgical planning and navigation plan were based on preoperative CT datasets. Through IGT-Link port, mixed reality workstation was synchronized with surgical navigation, and surgical planning data were transferred to the mixed reality workstation. Osteotomy lines were marked with the aid of both surgical navigation and mixed reality images visualized through HoloLens. Frozen section examination was used to ensure negative surgical margins. Postoperative CT datasets were obtained 1 week after the surgery, and chromatographic analysis of virtual osteotomies and actual osteotomies was carried out. Patients received standard oncological postoperative follow-up. RESULTS: Of the seven patients, four had maxillary tumors and three had mandibular tumors. There were total of 13 osteotomy planes. Mean deviation between the planned osteotomy plane and the actual osteotomy plane was 1.68 ± 0.92 mm; the maximum deviation was 3.46 mm. Chromatographic analysis showed error of ≤3 mm for 80.16% of the points. Mean deviations of maxillary and mandibular osteotomy lines were approximate (1.60 ± 0.93 mm vs. 1.86 ± 0.93 mm). While five patients had benign tumors, two had malignant tumors. Mean deviations of osteotomy lines was comparable between patients with benign and malignant tumors (1.48 ± 0.74 mm vs. 2.18 ± 0.77 mm). Intraoperative frozen pathology confirmed negative resection margins in all cases. No tumor recurrence or complications occurred during mean follow-up of 15.7 months (range, 6-26 months). CONCLUSION: The combination of mixed reality technology and surgical navigation appears to be feasible, safe, and effective for tumor resection in the oral and maxillofacial region.