Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore.
Department of Oral and Plastic Maxillofacial Surgery, Heinrich-Heine University Hospital, Dusseldorf, Germany.
J Craniomaxillofac Surg. 2024 Nov;52(11):1274-1287. doi: 10.1016/j.jcms.2024.08.010. Epub 2024 Aug 22.
The transfer of a virtual orthognathic surgical plan to the patient still relies on the use of occlusal splints, which have limitations for vertical positioning of the maxilla. The use of real-time navigation has been proposed to enhance surgical accuracy. This systematic review (PROSPERO CRD42024497588) aimed to investigate if surgical navigation can improve the three-dimensional accuracy of orthognathic surgery. The inclusion criteria were orthognathic surgery, use of intra-operative navigation and quantitative assessment of surgical accuracy. The exclusion criteria were non-bimaxillary orthognathic surgeries, non-clinical studies, studies without post-operative 3D analysis and publications not in the English language. A search of PubMed, Embase and Cochrane Library generated 940 records, of which 12 were found relevant. Risk of bias was assessed done using the Joanna Briggs Institute Critical Appraisal Checklist Tool. Among the included studies, there were nine of observational character and three randomized control studies (RCTs). All studies demonstrated promising outcomes with reported good surgical accuracy within a 2 mm difference between the planned and post-surgical result. Meta-analysis of two RCTs was carried out and results were in favor of surgical navigation with a total odds ratio of 4.44 [2.11, 9.37] and an overall effect outcome of Z = 3.92 (p < 0.0001). Navigation was up to 0.60 mm more accurate than occlusal wafers only (p < 0.001). However, there were variations in the application of surgical navigation and methods of analysis, leading to a heterogenous data set. Future studies should focus on standardized protocols and analysis methods to further validate the use of surgical navigation in orthognathic surgery. Despite some limitations, surgical navigation shows potential as a valuable tool in improving the accuracy of orthognathic surgery.
虚拟正颌手术计划向患者的转移仍然依赖于咬合夹板的使用，但这种方法在对上颌骨的垂直定位方面存在局限性。因此，已经提出使用实时导航来提高手术准确性。本系统评价（PROSPERO CRD42024497588）旨在研究手术导航是否可以提高正颌手术的三维准确性。纳入标准为正颌手术、术中导航的使用以及手术准确性的定量评估。排除标准为非双颌正颌手术、非临床研究、无术后 3D 分析的研究以及非英语语言发表的出版物。通过对 PubMed、Embase 和 Cochrane Library 的检索，共生成 940 条记录，其中有 12 条被认为相关。使用 Joanna Briggs 研究所的批判性评价清单工具对偏倚风险进行了评估。纳入的研究中，有 9 项为观察性研究，3 项为随机对照研究（RCT）。所有研究均报告了良好的手术准确性，计划与术后结果之间的差异在 2 毫米以内，结果有一定的前景。对两项 RCT 进行了荟萃分析，结果支持手术导航，总优势比为 4.44 [2.11, 9.37]，总效应结局 Z 值为 3.92（p < 0.0001）。导航比仅使用咬合片的准确性高 0.60 毫米（p < 0.001）。然而，手术导航的应用和分析方法存在差异，导致数据集存在异质性。未来的研究应侧重于标准化的方案和分析方法，以进一步验证手术导航在正颌手术中的应用。尽管存在一些局限性，但手术导航显示出作为提高正颌手术准确性的有价值工具的潜力。
