Evolution of Computer-aided Surgery in a Tertiary Pediatric Craniofacial Practice
Anthony Azzolini, MD, Wen Xu, MD, Katherine Magoon, MD, Robin Yang, MD, DDS, Scott P. Bartlett, MD, Jordan Swanson, MD, Jesse Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
A measure of a technique or tool’s utility is its usage over time, with increasing use denoting increased utility. The purpose of this study is to evaluate the evolving utilization of computer-aided surgery (CAS) for index pediatric craniofacial procedures at a tertiary, pediatric craniofacial center.
Our prospective pediatric craniofacial registry was queried for index pediatric craniofacial procedures involving the use of CAS from July 2011 to December 2018. Index procedures were categorized as orthognathic, mandibular distraction (MDO), cranioplasty, cranial vault reconstruction (CVR), craniofacial free tissue transfer (CFTT), hypertelorism, and complex/miscellaneous. Utilization of CAS, the role it played, and trends over time were compared with appropriate statistical methods.
162 cases were identified during the study period. CAS was most commonly utilized for orthognathic (n= 100, 61.7%), CFTT (n=18, 11.1%), MDO (n=16, 9.9%), and complex/miscellaneous (n=16, 9.9%) cases. It was least commonly used for cranioplasty (n=9, 5.6%), hypertelorism (n=2, 1.2%), and CVR (n=1, 0.6%). Spearman correlation showed significant increase in number of CAS cases per year (p<0.001), with the largest increase in percentage of orthognathic cases (p=0.018). There is an evolving role for CAS specifically in orthognathic cases, where typical deliverables now including dental splints (85%), custom LeFort plates (32.5%), and custom BSSO plates (20%)(p<0.001).
CAS utilization for index craniofacial procedures is increasing over time at our institution, especially in orthognathic surgery, signaling recognized utility of this tool / technique. Deliverables for CAS are also in evolution, with an increasing role for CAS-generated custom implants. It will be interesting to continue to monitor this trend as new uses of CAS come to market.
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