# Evaluation of HMDs by QFD for Augmented Reality Applications in the Maxillofacial Surgery Domain
###### Abstract  
Today, surgical operations are less invasive than they were a few decades ago and, in medicine, there is a growing trend towards precision surgery. Among many technological advancements, augmented reality (AR) can be a powerful tool for improving the surgery practice through its ability to superimpose the 3D geometrical information of the pre-planned operation over the surgical field as well as medical and instrumental information gathered from operating room equipment. AR is fundamental to reach new standards in maxillofacial surgery. The surgeons will be able to not shift their focus from the patients while looking to the monitors. Osteotomies will not require physical tools to be fixed on patient bones as guides to make resections. Handling grafts and 3D models directly in the operating room will permit a fine tuning of the procedure before harvesting the implant. This article aims to study the application of AR head-mounted displays (HMD) in three operative scenarios (oncological and reconstructive surgery, orthognathic surgery, and maxillofacial trauma surgery) by the means of quantitative logic using the Quality Function Deployment (QFD) tool to determine their requirements. The article provides an evaluation of the readiness degree of HMD currently on market and highlights the lacking features.  
m xallofacial surgery; precision medicine; computer-assisted surgery; quality function deployment; head mounted display +
Footnote †: journal: Medical Surgery Domain.  
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may support the knowledge transfer between specialists (e.g., clinician or specialist) and those seeking understanding and insight (e.g., patient and relatives, learners, etc.) [11].  
The previous brief overview shows how the lack of a common investigation methodology leads to a fragmentation of the information. This scientific analysis aims to converge on a standard method and to define guidelines for a handbook of AR applications in surgical practice.  
The saying \"beauty is only skin deep\" could be further from reality when considering how the underlying structure of the maxillofacial region provides the foundation of our appearance. The maxillofacial region importance goes far beyond appearance: it provides protection to the cranium and critical functions including sight, smell, taste, talking and breathing. For this reason, any injury or disorder in the maxillofacial region must be treated thoroughly as it can, sometimes, be life-changing or even life-threatening. Therefore, maxillofacial surgery procedures are crucial and performing surgery on such a critical region requires particular care, as difficulties or mistakes may put heavy tolls on patients.  
Maxillofacial surgery has been chosen as the cornerstone of this study due its importance, hence the extensive consultable literature. Three practices were identified as those that benefit the most from AR: oncologic and reconstructive surgery, orthognathic surgery, and maxillofacial trauma surgery. This study investigates the distinctive traits of each scenario (e.g., common practice, operations timing, useful features, etc.), extrapolates the requirements, and seeks the more fitting AR devices' specifications.  
After this brief introduction of the study subject, the next section will present the method focused on maxillofacial common surgical procedures and AR devices. The results will be reported in a dedicated section and, after a brief discussion, conclusions will be drawn about the more appropriate solutions to apply AR to maxillofacial surgery.