Surgical Ergonomics in Craniofacial Surgery: Evaluation of Surgeon Posture

Poor operating room ergonomics contribute significantly to musculoskeletal strain among surgeons. Craniofacial surgery presents unique ergonomic challenges due to variable operative fields, yet objective data characterizing ergonomic risk across craniofacial procedures remain limited.

A prospective study was conducted at a single academic institution, measuring surgeon posture during craniofacial procedures. Surgeons at varying levels of training wore a continuous posture-monitoring device during craniofacial cases to measure cervical and thoracic alignment relative to an individualized neutral baseline. Time in upright versus non-neutral posture was recorded. Associations between posture and surgeon height, level of training, gender, and procedure type were analyzed using ANOVA and post hoc Tukey testing.

Five surgeons contributed data from 48 surgical cases across 8 procedure categories, yielding 72 analyzable data points. The proportion of time in upright posture varied significantly by surgeon height and training level (P<0.05), with surgeons at shorter or taller height extremes and residents demonstrating worse posture. Gender was not significantly associated with posture (P=0.12). Overall differences among procedure types were not significant (P=0.17); however, post hoc analysis revealed significant pairwise differences. Intraoral procedures, including cleft palate repair, orthognathic surgery, and alveolar bone grafting, were associated with lower proportions of upright posture compared with external procedures such as cleft lip repair and craniosynostosis surgery.

Craniofacial surgeons spend a substantial proportion of operative time in non-neutral posture, with ergonomic risk influenced by surgeon height, training level, and procedure-specific demands. Objective posture monitoring identifies high-risk scenarios and supports targeted interventions to reduce musculoskeletal injury risk.