From Computer-Assisted Surgery to Extended Reality: Research Trends, Global Collaboration, and Future Directions in...

Background: Extended reality (XR) technologies, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), are increasingly used in craniomaxillofacial (CMF) surgery; yet, no study has systematically mapped the global development of this research. This study provides the first comprehensive evidence mapping of XR and related computational technologies in CMF surgery, identifying research trends, collaborative networks, and future directions. Methods: A systematic search of the Web of Science (WoS) Core Collection (data extracted April 2025) combined XR terms (AR, MR, VR, image-guided surgery, and computer-assisted surgery) with CMF surgery terminology. After applying the inclusion criteria, 778 English-language articles published between 1988 and 2024 were analyzed using performance analysis and science mapping tools, including HistCite and VOSviewer. Results: Publication output grew exponentially, accelerating markedly after 2010. The Journal of Cranio-Maxillofacial Surgery led in both volume and internal citation impact. The USA, Germany, and China accounted for most of the output, with Germany showing a disproportionately high internal citation impact relative to its publication volume. Three developmental phases were identified: foundational computer-assisted surgery (1990s-2000s), technological development and validation (2000s-2010s), and clinical application optimization centered on AR and VR (2010s-present). Co-authorship networks revealed strong regional clusters with limited cross-cluster connectivity. No publications were identified from African countries other than Egypt. Conclusions: XR research in CMF surgery has grown substantially over 36 years, with a clear shift toward AR and VR applications. Geographic concentration limited international collaboration, and a focus on technical rather than patient-centered outcomes remains a key challenge. Future work should prioritize global participation, comparative clinical evidence, and patient-reported outcomes to support wider surgical adoption.