Accuracy of virtual planning and intraoperative navigation in zygomaticomaxillary complex fractures: A systematic review

Abstract

ObjectiveThis systematic review aims to investigate the effect of virtual planning on the treatment of zygomaticomaxillary complex (ZMC) traumatology followed by intraoperative navigation. Furthermore, clinical outcomes following intraoperative navigation surgery or conventional surgery will be compared. Materials and methodsA systematic literature search was conducted in PubMed, Embase, Web-of-Science, and Cochrane on January 1st, 2022. Inclusion criteria were articles using preoperative three-dimensional (3D) virtual planning combined with intraoperative navigation or comparing these 3D methods with conventional methods. Furthermore, at least one of the following outcomes needed to be included in the article: technical accuracy of the procedure, preoperative planning time, operative time, number of fixation points, patient satisfaction, complications, or total costs of the intervention. ResultsFollowing the screening of 4478 articles, 17 were included. Five articles appeared to indicate a significantly better technical linear accuracy, one article reported better accuracy for rotation and two articles showed better accuracy in restoring orbital volume when using navigation. Nine articles investigated operative time with varying results. Seven articles calculated the additional costs, of which three concluded no extra cost while the others indicated high additional costs or questionable cost-effectiveness. ConclusionVirtual planning and intraoperative navigation technologies have the potential to assist maxillofacial trauma surgeons in reducing ZMC fractures significantly more accurately and restoring the facial contour in a less invasive manner at an acceptable cost. RegistrationThe protocol for this systematic review (CRD42020216717) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).