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Computer Aided Design and Manufacturing in Non-syndromic Cranial Vault Reconstruction Is Not Associated with Improved Surgical Outcomes: A Single-Institution’s Experience
Joseph Lopez, MD MBA, Regina Cho, BA, Melanie Major, BA, Jens Berli, MD, Ricardo Bello, MD, Mundinger S. Gerhard, MD, Anh S. Edward, MD, Miguel Medina, III, MD, Amir H. Dorafshar, MBChB.
Johns Hopkins Hospital, Baltimore, MD, USA.

Purpose:
The surgical correction of pediatric cranial deformities has in the past two decades undergone a large paradigm shift. The development of computer-aided design & manufacturing (CAD/CAM) has the potential to revolutionize craniofacial reconstruction. Although the adoption of CAD/CAM has rapidly expanded, there is a paucity of data exploring whether its use improves surgical outcomes over conventional methods.
Methods:
A retrospective cohort with matched design was conducted for patients with non-syndromic craniosynostosis (NSC) who underwent primary cranial vault remodeling from 2009-2015. Patient demographics and characteristics were recorded. Postoperative outcomes were assessed by assigning each procedure to a Whitaker category. Secondary post-operative outcomes were recorded including complications, operative time, and length of stay. We used parametric and non-parametric statistical tests for matched data to assess the association between use of CAD/CAM and surgical outcomes.
Results:
A total 40 patients were identified in this study period. CAD/CAM-cases (n = 20) and matched controls (n = 20) did not differ in baseline characteristics. Whitaker scores of 2 or more were more common in CAD/CAM-cases (25%), than controls (5%), which was statistically significant (p=0.046). However, among secondary outcomes, we found no difference in intra-operative and post-operative complications between CAD/CAM-cases and controls. Although use of CAD/CAM was associated with shorter length of stay (p=0.016), there was a trend towards longer operative time with the use of CAD/CAM (p=0.052).
Conclusion:
Our findings provide evidence that CAD/CAM may not improve the efficiency of craniofacial reconstruction and help optimize surgical outcomes.


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