The state of virtual surgical planning in maxillary Reconstruction: A systematic review

Teffran J Chan; Cai Long; Edward Wang; Eitan Prisman

doi:10.1016/j.oraloncology.2022.106058

The state of virtual surgical planning in maxillary Reconstruction: A systematic review

Oral Oncol. 2022 Oct:133:106058. doi: 10.1016/j.oraloncology.2022.106058. Epub 2022 Aug 8.

Authors

Teffran J Chan¹, Cai Long², Edward Wang³, Eitan Prisman⁴

Affiliations

¹ Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: teffan.chan@alumni.ubc.ca.
² Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³ Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: eitan.prisman@ubc.ca.

PMID: 35952582
DOI: 10.1016/j.oraloncology.2022.106058

Abstract

Virtual surgical planning (VSP) and computer aided design utilization in head and neck reconstruction has become increasingly popular within the discipline. Advocates of the technology over traditional free hand surgery cite benefits including improved intraoperative efficiencies and postoperative outcomes that have been demonstrated during mandibular reconstruction. More recently, VSP for maxillary and mid facial reconstruction, generally considered more complex than their mandibular counterparts, have been applied with the hopes of similar benefits. However, our literature search revealed no large-scale randomized control trial substantiating these benefits. As such, the aim of this review was to synthesize the existing research on utilization of VSP in the context of maxillary reconstruction. Three databases were systematically searched for articles pertaining to maxillary reconstruction for oncologic, traumatic, or osteoradionecrosis indications. Four hundred and fourteen unique articles were reviewed by two independent reviewers ultimately revealing sixteen studies appropriate for qualitative synthesis including 142 patients. Results of our studies reveal the extreme heterogenicity of application of this technology under the label of virtual surgical planning. Outcome reporting methods were grossly inconsistent amongst all the articles resulting in inability to appropriately synthesize data quantitatively for a meta-analysis. Overall, there was no standard of reporting outcomes of maxillary reconstruction, and no randomized trials comparing virtual surgical planning versus freehand surgery and therefore there is insufficient data to objectively prove purported benefits. To facilitate future comparative studies, a minimal standard of reporting for maxillary VSP is presented and the need for a randomized control trial is highlighted.

Keywords: Computer aided design; Free flap reconstruction; Head and neck oncology; Maxillary reconstruction; Virtual surgical planning.

Publication types

Review
Systematic Review

MeSH terms

Computer-Aided Design
Free Tissue Flaps* / surgery
Humans
Mandibular Reconstruction* / methods
Maxilla / surgery
Plastic Surgery Procedures* / methods
Randomized Controlled Trials as Topic
Surgery, Computer-Assisted* / methods