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Time matters - differences between virtual surgical planning and conventional planning in cranio-maxillofacial surgery: a systematic review and meta-analysis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
(English)In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020Article in journal (Refereed) Submitted
Abstract [en]

The aim of the study was to assess if there is a time difference (operative time, ischemia time, planning time and hospitalization) between virtual surgical planning (VSP) and conventional planning in cranio-maxillofacial surgery (CMF). An electronic search was performed in June 2018. Studies comparing time difference between VSP and traditional planning were included. A meta-analysis was undertaken to demonstrate the difference between the groups regarding operative time, ischemia time and hospitalization duration for CMF reconstruction. 27 publications were included, with 524 patients in the VSP group and 770 in the control group. Most studies reported on mandible/maxilla reconstruction and the meta-analysis showed a decreased operative time for the VSP group with a mean difference of -84.61 min (95%CI -106.77, -62,45, p<0.00001). Ischemia time was also decreased, with a mean difference of -36.14 min (95% confidence interval -50.57, -21.71, p<0.00001). This systematic review and meta-analysis suggests that VSP is shortening the operation time and ischemia time for reconstructive CMF surgery. VSP also seems to shorten the preoperative planning time for orthognathic surgery.

National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-377725OAI: oai:DiVA.org:uu-377725DiVA, id: diva2:1291471
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25
In thesis
1. On Virtual Surgical Planning in Cranio-Maxillofacial Surgery
Open this publication in new window or tab >>On Virtual Surgical Planning in Cranio-Maxillofacial Surgery
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The complex three-dimensional (3D) anatomy of the cranio-maxillofacial (CMF) region makes surgery a challenging task. Virtual surgical planning (VSP) has the potential to increase accuracy, reproducibility and shorten operation time. Key challenges in VSP are to accurately separate, or segment, certain structures of interest, such as the orbit, from the rest of the image, as well as to create an accurate 3D model of the facial bones and dentition for orthognathic surgery planning. The time required for planning and fabrication of guides for trauma surgery is another challenge. The overall aim of this thesis was to develop and evaluate new virtual planning tools for CMF-surgery and to investigate their usefulness. Study I, II discuss and evaluate image fusion of CT/CBCT and intraoral scanning for orthognathic surgery. A method for virtual bite registration in centric relation (CR) was also proposed. The workflow has the potential to eliminate traditional laboratory work, and may facilitate 3D computer-assisted-planning in orthognathic surgery. Study III deals with orbit segmentation and presents a semi-automatic method, using a deformable model tracing the inside of the orbit via haptic 3D interaction. The method was validated in retrospective unilateral orbital fracture cases. The fractured orbits were compared to the intact side by volume and shape analyses. The method showed high accuracy, precision, time-efficiency and thereby potential to be a powerful tool for planning and evaluating reconstruction of orbital fractures. Study IV evaluates an in-house haptic-assisted VSP system for complex mandibular fractures on a series of retrospective cases and an artificial case. The system showed high precision and time-efficiency, but relatively low accuracy. This study proposes a novel, fast and user-friendly way of integrating VSP into planning mandible trauma surgery and could help in reducing operating time and increase accuracy. Study V is a systematic review and meta-analysis studying potential time benefits using VSP in CMF surgery. The study suggests that VSP shortens the operating time and ischemia time for reconstructive surgery. VSP also appears to shorten the preoperative planning time for orthognathic surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 81
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1544
Keywords
Virtual surgical planning. Computer assisted planning. 3D computer model. Orbital segmentation. Craniomaxillofacial surgery planning. Haptics.
National Category
Surgery Medical Image Processing
Research subject
Oral and Maxillofacial Surgery
Identifiers
urn:nbn:se:uu:diva-377726 (URN)978-91-513-0583-7 (ISBN)
Public defence
2019-04-12, Robergsalen, Uppsala University Hospital, entrance 40, 4th floor, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2019-03-19 Created: 2019-02-25 Last updated: 2019-05-07

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