Accuracy of surgical navigation for patient-specific reconstructions of orbital fractures: A systematic review and meta-analysis

• Published in: Journal of stomatology, oral and maxillofacial surgery Vol. 125; no. 3; p. 101683
• Main Authors: Verbist, Maarten, Dubron, Kathia, Bila, Michel, Jacobs, Reinhilde, Shaheen, Eman, Willaert, Robin
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.06.2024
• Subjects: Humans; Imaging, Three-Dimensional - methods; Medicin och hälsovetenskap; Orbital fractures; Orbital Fractures - diagnosis; Orbital Fractures - surgery; Orbital implants; Plastic Surgery Procedures - methods; Surgery, computer-assisted; Surgery, Computer-Assisted - methods; Surgical navigation systems; Technical accuracy; Tomography, X-Ray Computed; Virtual surgical planning; Orbital fractures; Virtual surgical planning; Orbital implants; Surgery, computer-assisted; Technical accuracy; Surgical navigation systems
• ISSN: 2468-7855; 2468-7855
• DOI: 10.1016/j.jormas.2023.101683

This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques. A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles. After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm3 ± 0.47 cm3) when surgical navigation was used compared with conventional surgery (2.17 cm3 ± 1.35 cm3). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used. Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.