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Lessons Learned From 12 Years Of Virtual Surgical Planning: Changing The Game In Craniomaxillofacial Surgery
Nicholas A. Han, BSE, Philip D. Tolley, MD, Gerardo A. Perla, BA, Allison C. Hu, MD, Isabel A. Ryan, BS, Jordan W. Swanson, MD, MSc, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: Virtual surgical planning continues to fuel innovation in cranio-maxillofacial surgery through custom implants, cutting guides, and 3D models. This study aims to examine the rapid evolution of virtual surgical planning (VSP) in pediatric craniofacial procedures, highlighting where it has "changed the game" and where it has not.
METHODS: We retrospectively reviewed all patients undergoing major craniofacial osteotomies from 2011 to 2023 for VSP usage and the specific deliverables for each case.
RESULTS: Of the 2468 index craniofacial procedures performed by our department from 2011 to 2023, 407 cases were virtually planned (16.5%). VSP utilization increased significantly over this period, from 2.0% in 2011 to 30.9% in 2023 (ANOVA p<0.001). VSP was most frequently used in orthognathic surgeries (n=272, 66.8%). From 2011-2014, VSP was solely applied to orthognathic and midface cases, with the addition of box osteotomies for hypertelorism in 2014, cranioplasties in 2016, fronto-orbital advancements in 2019, and facial feminization in 2023 (Figure 1). VSP significantly decreased time under anesthesia in bimaxillary orthognathic cases compared to traditionally planned cases (172 vs 217 min, p=0.003).
CONCLUSION: Our study highlights the significant evolution of VSP usage within our department, providing measurable benefits to both the patient and surgeon. As advancements in the technology continues to progress, the expanding affordability and efficiency of VSP will likely drive its adoption in a broader range of procedures.
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