C o m p u t e r- A s s i s t e d
Craniomaxillofacial
Surgery
Sean P. Edwards, DDS, MD, FRCD(C)
KEYWORDS
 Computer-assisted surgery  Computer-aided surgery
 Cone beam computed tomography
 Reconstructive surgery planning  Distraction osteogenesis
 Template
How often should results go according to plan? No
surgeon is perfect all the time yet surgery is a disci-
pline driven by results. Surgeons have therefore
turned to technology to improve not only their
outcomes but also how often they achieve high-
quality results.
Computer-assisted surgery (CAS) is an umbrella
term used to describe all forms of surgery planning
or execution that incorporate various forms of
advanced imaging, software, analysis, and plan-
ning and, in some cases, rapid prototyping (RP)
technology, robotics, and image-guidance systems.
Although these may represent the current state of
affairs, innovation is progressing rapidly, and new
forms of technology continue to be incorporated
and evaluated for their value in improving
operations.
As is often the case with the introduction of new
technology, critics of CAS abound. The techniques
are in their infancy and still have much to prove.
Critics often point to the increased direct costs
that may result from these technologies. Although
the direct costs of an operation may be increased,
the overall cost of care may be reduced.
Decreased operative time, blood loss, complica-
tions, and the need for reoperative surgery are all
potential cost-saving benefits. Minimally invasive,
or at least less invasive, approaches may also
result from improved planning and visualization.
These are value-added components of care and
may ultimately decrease hospitalization and
Department of Pediatric Maxillofacial Surgery, C.S. Mott Children’s Hospital, University of Michigan Health
System, TC B1 208, 1500 East Medical Center, Dr Ann Arbor, MI 48109-0018, USA
E-mail address: seanedwa@med.umich.edu
Oral Maxillofacial Surg Clin N Am 22 (2010) 117–134
doi:10.1016/j.coms.2009.11.005
1042-3699/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.
recovery time, thereby reducing morbidity and
the indirect costs of care.
These techniques may also increase the time
spent preparing for surgery. The value of planning
is not lost on orthodontists and oral and maxillofa-
cial surgeons. Each surgeon performs model
surgery and diagnostic set-ups, makes splints,
reviews clinical photographs, and performs ceph-
analyses to prepare for surgery. The value of this
time investment has been recognized for several
decades as critical to achieving consistent high-
quality results. Because these methods are new
and not standardized, little effort has been
directed at evaluating the benefits of CAS in cost
and treatment time, although this evaluation needs
to be accomplished before the techniques can
become standard.
Interest in this field is broad. In addition to cranio-
maxillofacial surgery, this technology has been
incorporated into orthodontics, radiation oncology,
neurosurgery, sinus surgery, joint replacement
surgery, spine surgery, and dental implantology.
The acceleration in interest in CAS is a result of the
increased availability of lower-cost, low-radiation
imaging technology and powerful, commercially
available software packages that allow a surgeon,
without sophisticated computer expertise, to visu-
alize and simulate operations. RP and stereolithog-
raphy (SLA) became commonplace in the late
oralmaxsurgery.theclinics.com
1990s and have been coupled with enhanced soft-
ware planning to push the technology forward.