Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of British Columbia, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Oral Oncol. 2022 Oct;133:106058. doi: 10.1016/j.oraloncology.2022.106058. Epub 2022 Aug 8.
Virtual surgical planning (VSP) and computer aided design utilization in head and neck reconstruction has become increasingly popular within the discipline. Advocates of the technology over traditional free hand surgery cite benefits including improved intraoperative efficiencies and postoperative outcomes that have been demonstrated during mandibular reconstruction. More recently, VSP for maxillary and mid facial reconstruction, generally considered more complex than their mandibular counterparts, have been applied with the hopes of similar benefits. However, our literature search revealed no large-scale randomized control trial substantiating these benefits. As such, the aim of this review was to synthesize the existing research on utilization of VSP in the context of maxillary reconstruction. Three databases were systematically searched for articles pertaining to maxillary reconstruction for oncologic, traumatic, or osteoradionecrosis indications. Four hundred and fourteen unique articles were reviewed by two independent reviewers ultimately revealing sixteen studies appropriate for qualitative synthesis including 142 patients. Results of our studies reveal the extreme heterogenicity of application of this technology under the label of virtual surgical planning. Outcome reporting methods were grossly inconsistent amongst all the articles resulting in inability to appropriately synthesize data quantitatively for a meta-analysis. Overall, there was no standard of reporting outcomes of maxillary reconstruction, and no randomized trials comparing virtual surgical planning versus freehand surgery and therefore there is insufficient data to objectively prove purported benefits. To facilitate future comparative studies, a minimal standard of reporting for maxillary VSP is presented and the need for a randomized control trial is highlighted.
虚拟手术规划 (VSP) 和计算机辅助设计在头颈部重建中的应用在该领域越来越受欢迎。该技术的支持者相对于传统的徒手手术，声称其具有改善术中效率和术后结果的优势，这些优势在下颌骨重建中得到了证实。最近，VSP 用于上颌骨和中面部重建，通常被认为比下颌骨重建更复杂，也被应用于希望获得类似的益处。然而，我们的文献检索没有发现大规模的随机对照试验来证实这些益处。因此，本综述的目的是综合现有的关于 VSP 在上颌骨重建中的应用的研究。我们系统地检索了三个数据库，以获取有关肿瘤、创伤或放射性骨坏死适应证的上颌骨重建的文章。两名独立的审查员对 414 篇独特的文章进行了审查，最终有 16 项研究适合定性综合，包括 142 名患者。我们的研究结果表明，这项技术在虚拟手术规划的标签下的应用具有极高的异质性。所有文章的结果报告方法都非常不一致，因此无法进行适当的定量数据综合进行荟萃分析。总体而言，上颌骨重建的结果报告没有标准，也没有比较虚拟手术规划与徒手手术的随机试验，因此没有足够的数据客观证明所声称的益处。为了促进未来的比较研究，提出了上颌骨 VSP 的最低报告标准，并强调需要进行随机对照试验。
