Oral and maxillofacial tumors involving the jaw are commonly treated with surgical resection (Alfouzan, 2018; Liu et al., 2019). Defects caused by surgical resection impair not only the patient's aesthetic appearance, but also oral functions, such as swallowing, chewing, and speech. More than 50% of these patients require bone or soft-tissue repair and reconstruction (Kim et al., 2020). Pedicled bone flap transplantation has become the gold standard for repairing mandibular defects (Kanazawa et al., 2011). As a long bicortical bone with long vascular pedicles and muscles, the fibula can adapt well to the natural contour of the mandible after plasticization, making it one of the most common donor bones (Zhang et al., 2016). Precise mandibular tumor resection and defect reconstruction can increase the radical cure rate and quality of life after surgery.

Surgical guides and surgical navigation remain limited in treating maxillofacial diseases, such as jaw tumor, trauma, or deformity (Weitz et al., 2018). The surgical guide is usually bulky, and requires time for production by a third-party company, using expensive equipment, which makes it unsuitable for acute trauma patients (Rodby et al., 2014). Once the surgical plan changes, the surgery cannot be immediately adjusted, because the surgical guide has already been printed (Pietruski et al., 2015). The expensive surgical guide can pose a substantial economic burden on patients (Mazzoni et al., 2013). In addition, only a sizeable surgical field can allow the surgical guide to fit the target area effectively, and thus extensive surgical trauma is inevitable. Furthermore, soft tissue is not considered in the design and manufacture of the surgical guide. Soft tissue on the bone surface may decrease the tightness between the surgical guide and the bone. Surgical navigation systems are also expensive, which restricts their widespread use. The navigation is based on preoperative imaging data, such as computer tomography (CT) and magnetic resonance imaging (MRI). The accuracy of navigation often decreases with image drift caused by various factors, such as intraoperative soft- and hard-tissue resection, tissue swelling and displacement, registration errors, and interference of signal conduction (Nijmeh et al., 2005).

Augmented reality (AR), as an emerging technology, is superior in terms of its real-time display of three-dimensional (3D) surgical plans, 3D registration, convenient preoperative preparation and intraoperative use, and time-saving. It can simplify preoperative planning and prevent intraoperative hand–eye incongruity (Léger et al., 2017). This technique has been applied in various clinical operations, including dynamic hip screw implantation for hip fractures, resection of liver tumors, and repair of unilateral orbitozygomatic maxillary complex fractures (Arikatla et al., 2018; Chen et al., 2015, 2020; Liu et al., 2015; McJunkin et al., 2018; Qu et al., 2014). However, AR surgical systems dedicated to jaw tumor resection and defect reconstruction have never been reported.

Thus, our study aimed to verify the feasibility and accuracy of a contour registration-based AR system through preclinical trials (model trials and animal trials), and to compare the outcomes of the system and the surgical guide, thus providing theoretical support for the clinical application of this system.