Robotic Skull Contouring for Facial Reconstruction-A Cadaveric Study

Orbital trauma is a complex facial injury that can result in significant morbidity secondary to functional and cosmetic changes. Autologous calvarial bone grafting remains the gold standard in addressing orbital fractures, offering good biocompatibility and robust long-term outcomes. However, manual carving of the bone grafts is time-consuming and can increase the risk of inaccuracies that can affect cosmesis and function.

The authors set out to evaluate the accuracy and efficiency of robotic bone graft carving in the repair of orbital defects.

Orbital defects were simulated in 8 orbits. Calvarial bone was harvested and carved with the robot using virtual preoperative planning. Accuracy of the reconstruction was measured using a surface deviation map. Efficiency was measured by looking at carving time. A retrospective chart review provided operative time benchmarks for similar defects in cases of manual carving.

Robotic carving achieved submillimeter accuracy (RMS 0.25-0.38 mm error). After multiple rounds of parametric optimization, carving time was also reduced from over 40 minutes to under 12 minutes. The average operative time after manual carving was 55 minutes.

Robotic-assisted bone carving offers a very precise and time-efficient alternative to manual bone carving in orbital reconstruction. With further validation in the operating room, this technique may enhance the accuracy of the reconstruction and significantly increase efficiency.