The Role of Intraoperative Navigation in Surgical Treatment of Unilateral Zygomatic Complex Fractures: A Systematic Review and Meta-Analysis

Purpose: The application of a computer-aided navigation system (CANS) in zygomatic complex (ZMC) fractures has been extensively reported, but individual results are heterogeneous. The purpose of this sys-tematic review was to evaluate the role of CANS in the surgical treatment of unilateral ZMC fractures. Methods: Electronic retrieval of MEDLINE, Embase, and Cochrane Library (CENTRAL) and manual search-ing until November 1, 2022 were used to identify cohort studies and randomized controlled trials employing CANS in the surgical treatment of ZMC fractures. The identified reports contained at least 1 of the following outcome variables: accuracy of reduction, total treatment time, amount of bleeding, postoperative complica-tions, satisfaction, and cost. Weighted or mean differences (MD), risk ratios, and corresponding 95% confi-dence intervals (CI) were calculated, where P<.05 and I2>50% random-effect model was adopted, and a vice versa fixed-effect model was adopted. Descriptive analysis was applied to qualitative statistics. The proto-col was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Ana-lyses (PRISMA) guidelines and prospectively registered with PROSPERO (CRD42022373135). Results: A total of 562 studies were identified, of which 2 cohort studies and 3 randomized controlled trials with 189 participants were included. Meta-analysis indicated that employing CANS significantly decreased the reduction error (MD = 0.86, 95% CI 1.58 to 0.14; P = .02, random-effect model) compared with conven-tional surgery without using CANS. The differences in total treatment time (preoperative planning time: MD = 1.44, 95% CI 3.55 to 6.43; P = .57 and operative time: MD = 3.02, 95% CI 9.21 to 15.26; P = .63, fixed-effect model) and amount of bleeding (MD = 14.86, 95% CI 8.86 to 38.58; P = .22, fixed-effect model) were not statistically significant between the two groups. Descriptive analysis suggested that postoperative complications, postoperative satisfaction, and cost were also similar with or without CANS. Conclusion: Within the limitations of the present review, the reduction accuracy of unilateral ZMC frac-tures using CANS is superior to that of conventional surgery. CANS presents limited influence on operation time, amount of bleeding, postoperative complications, postoperative satisfaction, and cost. & COPY; 2023 Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons