Abstract
Computer-assisted surgery (CAS) in maxillary reconstruction has proven its value regarding more predictable postoperative results. However, the accuracy evaluation methods differ between studies, and no meta-analysis has been performed yet. A systematic review was performed in the PubMed, Embase, and Cochrane Library databases, using a Patient, Intervention, Comparison and Outcome (PICO) method: (P) patients in need of maxillary reconstruction using free osteocutaneous tissue transfer, (I) reconstructed according to a virtual plan in CAS software, (C) compared to the actual postoperative result, and (O) postoperatively measured by a quantitative accuracy assessment) search strategy, and was reported according to the PRISMA statement. We reviewed all of the studies that quantitatively assessed the accuracy of maxillary reconstructions using CAS. Twelve studies matched the inclusion criteria, reporting 67 maxillary reconstructions. All of the included studies compared postoperative 3D models to preoperative 3D models (revised to the virtual plan). The postoperative accuracy measurements mainly focused on the position of the fibular bony segments. Only approximate comparisons of postoperative accuracy between studies were feasible because of small differences in the postoperative measurement methods; the accuracy of the bony segment positioning ranged between 0.44 mm and 7.8 mm, and between 2.90° and 6.96°. A postoperative evaluation guideline to create uniformity in evaluation methods needs to be considered so as to allow for valid comparisons of postoperative results and to facilitate meta-analyses in the future. With the proper validation of the postoperative results, future research might explore more definitive evidence regarding the management and superiority of CAS in maxillary and midface reconstruction.
Highlights
Ablative surgery of the maxilla can lead to a high level of functional impairment, and often causes a psychological and aesthetical trauma for the patient
Similar to our previously published systematic review on accuracy in mandibular reconstruction [13,14], we reviewed all studies that quantitatively assessed the accuracy of maxillary reconstruction performed with computer-assisted surgery (CAS) as mentioned above
According to the inclusion and exclusion criteria, 12 studies were applicable to the purpose of this systematic review, describing a total of 67 maxillary reconstructions using CAS [8,11,18,19,20,21,22,23,24,25,26,27]
Summary
Ablative surgery of the maxilla can lead to a high level of functional impairment, and often causes a psychological and aesthetical trauma for the patient. The goals of maxillary reconstruction are defect obliteration, support of midfacial elements, restoration of oral and nasal function, and restoration of facial aesthetics [6]. To achieve these goals, the bony maxillary reconstruction needs to be accurate for two reasons. High accuracy is essential when dental implants are placed during the reconstruction, in a guided fashion and in line with the antagonist dentition, in order to achieve optimal occlusion [8] This shortens the total oral rehabilitation time (TORT), reducing the time and costs, and potentially improving quality of life [9]
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