Virtual surgical planning in craniomaxillofacial surgery: A systematic review and meta-analysis of accuracy, operative time, and cost-effectiveness.

Abstract

Craniomaxillofacial surgeons address congenital, developmental, and acquired deformities of the cranium, face, and jaws, relying on precise planning for optimal outcomes. Virtual surgical planning (VSP) integrates digital imaging and computer-aided design to enhance preoperative planning and intraoperative precision. A systematic review and meta-analysis were conducted across databases, focusing on studies published between 2013 and 2023. The search terms included "Virtual Surgical Planning," "VSP," "Surgical Planning," "3D Printing," and "Craniofacial Surgeries" or "Craniomaxillofacial Surgeries." Articles that reported outcomes on operative time, accuracy, or cost were included. A total of 146 studies were included in the final analysis. The outcomes were grouped into 3 key categories: accuracy, operative time, and cost-effectiveness. VSP showed a median deviation of 1.14 mm compared to 1.83 mm for non-VSP (P = 0.46). VSP groups had an average angular deviation of 2.67°, compared to 3.32° for non-VSP groups (P = 0.805). The average matching percentage was 96.12% for VSP, compared to 87.5% for non-VSP (P = 0.264). Operative time for VSP was 3.7 h compared to 4.32 h for non-VSP (P = 0.477). Cost analysis showed VSP at a lower average material cost ($2128) compared to non-VSP ($3416) (P = 0.294). Although numerous studies highlight the advantages of VSP in the craniomaxillofacial field, our meta-analysis found no statistically significant differences compared to the traditional methods. Variability in study designs and outcome measures may contribute to these findings, highlighting the need for more standardized, procedure-specific research to fully assess the clinical impact of VSP.