Three-Dimensional Printing for Craniomaxillofacial Surgery: A Systematic Review and Meta-analysis of Applications and Logistical Outcomes

Abstract

Introduction: Three-dimensional (3D) printing plays a rapidly expanding role in the field of craniomaxillofacial (CMF) surgery; however, the time and costs required to efficiently utilize this technology are highly variable. To better delineate the temporal and financial resources needed to establish an efficient workflow, we conducted a systematic review and meta-analysis of studies utilizing patient-directed 3D-printed constructs in the setting of CMF surgery. Methods: A systematic review was performed using PubMed, Web of Science, and Embase. In total, 1679 articles were screened and 45 met inclusion criteria. Primary outcomes included the costs of 3D-printed constructs and the time required for virtual surgical planning (VSP), 3D printing, surgery, and hospitalization. Results: The aggregated data assessed 751 patients, 738 surgeries, and 1136 3D-printed constructs. The most common surgical indication was post-neoplastic reconstruction (n = 304), and the most common surgical procedure was mandibular reconstruction (n = 287). Printed constructs were as follows: contour models (44.1%), guides (30.9%), implants (12.5%), splints (12.1%), and prostheses (0.5%). Printing was the longest contributor to the preoperative workflow, averaging 401.6 minutes, while VSP required, on average, only 98.6 minutes. There was no significant difference in VSP time between constructs printed in-house and those contracted from commercial vendors. However, constructs printed in-house were significantly cheaper than those procured from vendors, averaging $252.20 and $2735.50, respectively ( P < .001). Of articles reporting intraoperative time (n = 19), 78.9% reported significant reductions when using 3D-printed constructs. Conclusion: 3D printing, especially in-house workflows, may reduce costs and improve efficiency for CMF surgery.