The Evolution of Virtual Surgical Planning in Craniomaxillofacial Surgery: A Comprehensive Review

Virtual surgical planning (VSP) has significantly transformed craniomaxillofacial surgery over the past 2 decades, leading to diverse applications and improved surgical outcomes. However, variations in technological approaches, clinical outcomes, and economic implications persist. This review aims to comprehensively examine the evolution of VSP in craniomaxillofacial surgery, assess its impact on surgical precision and patient outcomes, and identify current trends and future directions. A synthesis of current knowledge is essential to establish evidence-based guidelines for VSP implementation and optimize patient care in this rapidly advancing field.

A systematic literature search was conducted in PubMed, Embase, and IEEE Xplore databases from their inception to September 2024. Search terms included combinations of "virtual surgical planning" OR "computer-assisted surgery" AND "craniomaxillofacial" OR "maxillofacial" OR "craniofacial" AND "evolution" OR "development" OR "advancement". From 540 initially identified articles, studies focusing on VSP in craniomaxillofacial surgery that reported technological advancements, surgical outcomes, or precision metrics were included. Eligible studies comprised case series with 5 or more subjects, comparative studies, and validation studies. Data extraction included study characteristics, technology details, surgical applications, outcome measures, and economic factors. Quality assessment was performed using appropriate tools based on study design.

Out of 540 articles, 36 studies spanning from 1999 to 2024 met the inclusion criteria. The evolution of VSP was categorized into 3 phases: early foundations (1999 to 2004), expansion of applications and improved accuracy (2005 to 2014), and advanced integration with emerging technologies (2015 to 2024). Orthognathic surgery was the commonest application (52.8% of studies), followed by tumor resection and reconstruction (22.2%). Studies consistently demonstrated smaller linear discrepancies between planned and actual outcomes with VSP compared to conventional methods (VSP: 0.04 to 0.25 mm vs conventional: 0.29 to 1.33 mm). Recent advancements include the integration of artificial intelligence, mixed reality, and robotic systems, enhancing both preoperative planning and intraoperative guidance.

VSP has considerably evolved in craniomaxillofacial surgery, improving accuracy as demonstrated by reduced linear discrepancies between planned and actual outcomes across various procedures. While promising, challenges remain, including the need for standardization, comprehensive cost-effectiveness analyses, and long-term outcome studies.