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

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.