The Role of Intraoperative Navigation in Surgical Treatment of Unilateral Zygomatic Complex Fractures: A Systematic Review and Meta-Analysis

Abstract

The application of a computer-aided navigation system (CANS) in zygomatic complex (ZMC) fractures has been extensively reported, but individual results are heterogeneous. The purpose of this systematic review was to evaluate the role of CANS in the surgical treatment of unilateral ZMC fractures. Electronic retrieval of MEDLINE, Embase, and Cochrane Library (CENTRAL) and manual searching until November 1, 2022 were used to identify cohort studies and randomized controlled trials employing CANS in the surgical treatment of ZMC fractures. The identified reports contained at least 1 of the following outcome variables: accuracy of reduction, total treatment time, amount of bleeding, postoperative complications, satisfaction, and cost. Weighted or mean differences (MD), risk ratios, and corresponding 95% confidence intervals (CI) were calculated, where P＜.05 and I2＞50% random-effect model was adopted, and a vice versa fixed-effect model was adopted. Descriptive analysis was applied to qualitative statistics. The protocol was conducted in accordance with PRISMA guidelines and prospectively registered with PROSPERO (CRD42022373135). A total of 562 studies were identified, of which 2 cohort studies and 3 randomized controlled trials with 189 participants were included. Meta-analysis indicated that employing CANS significantly decreased the reduction error (MD=-0.86, 95% CI -1.58 to -0.14; P=.02, random-effect model) compared with conventional surgery without using CANS. The differences in total treatment time (preoperative planning time: MD=1.44, 95% CI -3.55 to 6.43; P=.57 and operative time: MD=3.02, 95% CI -9.21 to 15.26; P=.63, fixed-effect model) and amount of bleeding (MD=14.86, 95% CI -8.86 to 38.58; P=.22, fixed-effect model) were not statistically significant between the two groups. Descriptive analysis suggested that postoperative complications, postoperative satisfaction, and cost were also similar with or without CANS. Within the limitations of the present review, the reduction accuracy of unilateral ZMC fractures using CANS is superior to that of conventional surgery. CANS presents limited influence on operation time, amount of bleeding, postoperative complications, postoperative satisfaction, and cost.