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Virtual Surgical Planning in Pediatric Craniomaxillofacial Surgery: A 12-Year Institutional Experience
Nicholas A Han1, Philip D Tolley, Gerardo A Perla
1Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Pennsylvania, PA.
Insights
Virtual surgical planning (VSP) enhances pediatric craniofacial surgery precision. Its use expanded significantly from 2011-2023, particularly in orthognathic cases, reducing operative times with patient-specific implants.
Area of Science:
- Craniofacial Surgery
- Medical Technology
- Pediatric Surgery
Background:
- Virtual surgical planning (VSP) has advanced craniofacial surgery.
- Optimal applications of VSP in pediatric cases require further definition.
Purpose of the Study:
- To evaluate the evolution and expanding applications of VSP in pediatric craniomaxillofacial surgery.
- To analyze VSP utilization, including stereolithographic models, cutting guides, splints, and patient-specific implants.
Main Methods:
- Retrospective review of 2112 craniofacial procedures (2011-2023) at a tertiary pediatric hospital.
- Analysis of VSP utilization, demographic data, operative times, and surgical outcomes.
- Comparison of operative times for patient-specific implants versus traditional methods in bimaxillary orthognathic cases.
Main Results:
- 19.9% (n=420) of cases utilized VSP, most frequently in orthognathic operations (67.6%).
- VSP applications expanded over time to include various complex procedures.
- Patient-specific implants significantly decreased operative duration in bimaxillary orthognathic cases (207.5 min vs 234.0 min, P=0.021).
Conclusions:
- VSP is integral to pediatric craniofacial procedures demanding high precision or complex anatomy.
- VSP utility is currently limited in operations considering cranial growth.
- Advancements in 3D analysis and manufacturing may broaden VSP applications in pediatric craniomaxillofacial surgery.
Abstract:
Virtual surgical planning (VSP) has revolutionized craniofacial surgery by enhancing preoperative planning and surgical precision, though its optimal applications in pediatric cases remain incompletely defined. The purpose of this study is to evaluate the evolution and expanding applications of VSP in craniomaxillofacial surgery at our tertiary pediatric hospital. A retrospective review of index craniofacial procedures performed between 2011 and 2023 at a tertiary pediatric hospital was conducted, analyzing VSP utilization, including the use of stereolithographic models, cutting guides, splints, and patient-specific implants. Demographic data, operative times, and surgical outcomes were collected for all procedures. During the study interval, 2112 index craniofacial procedures were performed, of which 19.9% (n=420) cases were virtually planned. Virtual surgical planning was most frequently used in orthognathic operations (n=284, 67.6%). From 2011 to 2014, VSP was solely applied to orthognathic and midface cases, with the addition of box osteotomies for hypertelorism in 2015, cranioplasties in 2016, anterior vault advancements in 2019, and posterior/middle vault expansions in 2021. The use of patient-specific implants significantly decreased operative duration in bimaxillary orthognathic cases compared with traditional fixation methods (207.5 min versus 234.0 min, P =0.021). Virtual surgical planning has become integral to pediatric craniofacial procedures requiring high precision or involving complex anatomy, though its utility is currently limited in operations where cranial growth must be considered. As 3D analysis software and manufacturing advances, VSP may find broader applications in pediatric craniomaxillofacial surgery.
