The Impact of Virtual Surgical Planning on Orthognathic Surgery: A Comparison of Two Specialties
Mya Abousy, Jonlin Chen, Alisa Girard, Olga Duclos, Viren Patel, Hillary E. Jenny, Richard Redett, Robin Yang
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Background: Virtual surgical planning (VSP) is the gold standard for preoperative orthognathic surgery planning by surgeons trained in plastic and reconstructive surgery (PRS) or oral and maxillofacial surgery (OMS). This review assesses the introduction of VSP as a new technology and its impact on orthognathic surgery research and practices based upon surgeon training.
Methods: Two PubMed literature reviews were conducted. The first classified publications on VSP for orthognathic surgery by training (OMS- or PRS-trained surgeons) and compared focuses, timing, and journals of publications from each group of surgeons. The second evaluated how orthognathic surgery publication volumes changed with VSP introduction. English articles published from inception until January 2020 (first review) and November 2020 (second review) were included.
Results: A total of 419 publications regarding VSP in orthognathic surgery resulted from initial search. Of them, 244 publications were authored by oral and maxillofacial surgeons, 28 publications were by plastic surgeons, 34 were by surgeons with a background in both. Prior to 2008, VSP publications were predominately authored by OMS. The first PRS-authored publication in VSP use for orthognathic surgery was in 2009. There has since been a steady increase in both PRS- and OMS-authored papers regarding VSP use in orthognathic surgery (p<0.01). However, this increase in publications occurred at a slower rate and smaller quantities with PRS-authored publications than in OMS-authored publications (coefficient 0.16, p<0.01). Regarding publication content, OMS-authored publications focused on determining the accuracy of VSP methods (66.5% of all OMS-authored publications), anticipated stability and functionality of occlusion (26.3%), and the interplay between orthodontic treatments and orthognathic surgery (28.1%). PRS-authored publications discussed optimizing facial aesthetics and facial symmetry (80.7% of all included PRS-authored publications), surgical accuracy (69.2%), correction of congenital facial abnormalities (38.4%), and post-operative functionality (26.9%). In comparing PRS versus OMS-authored publications, PRS-authored studies focused significantly more on documenting VSP outcomes on facial aesthetics (p<0.01) and surgical correction of craniofacial anomalies (p<0.01).
Conclusions: VSP technology simplifies pre-operative planning, broadens the scope of specialties that can conduct orthognathic surgery, and increases continuity-of-care. Both OMS- and PRS-trained surgeons have contributed multifaceted research to this evolving surgical field.
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