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The Current State of Intraoperative Imaging in Maxillofacial Surgery: A Systematic Review
Charlotte Thomas1, Gary Dong2, Dorien I Schonebaum1,3
1Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Journal of Clinical Medicine
|February 27, 2026
Summary
Intraoperative imaging in maxillofacial surgery enhances accuracy and symmetry. However, varied reporting hinders comparisons, necessitating standardized prospective studies for clinical value.
Area of Science:
- Maxillofacial Surgery
- Medical Imaging
- Surgical Navigation
Background:
- Maxillofacial reconstruction demands precision; inaccuracies impact aesthetics, function, and safety.
- Preoperative imaging is standard, but intraoperative imaging offers real-time 3D guidance.
- Advances in intraoperative imaging may improve surgical outcomes in maxillofacial procedures.
Purpose of the Study:
- To review the application of intraoperative imaging in maxillary and mandibular surgery.
- To evaluate the impact of these technologies on surgical accuracy, efficiency, and outcomes.
- To identify current trends and limitations in the use of intraoperative imaging for maxillofacial reconstruction.
Main Methods:
- Conducted two systematic reviews (PROSPERO CRD420251125497, CRD420251124600) following PRISMA guidelines.
- Searched Cochrane, Medline, Embase, and Web of Science for studies on intraoperative imaging in maxillofacial surgery.
- Included 35 studies (1643 patients) focusing on techniques like intraoperative CT, stereotactic navigation, and augmented reality.
Main Results:
- 35 studies included, utilizing techniques such as intraoperative CT (34.3%) and stereotactic navigation (45.7%).
- Cone-beam CT (CBCT) and stereotactic navigation showed significant restoration of facial symmetry.
- Stereotactic navigation achieved accuracy under 2 mm; CBCT added minimal intraoperative time (1-20 min).
Conclusions:
- Various intraoperative imaging and navigation tools are used in maxillofacial surgery.
- Inconsistent reporting, small study sizes, and design limitations impede cross-technology comparisons.
- Standardized prospective studies are crucial to determine clinical value and guide adoption.
