Accuracy and stability of virtual surgical planning for maxillary advancement in patients with cleft lip and palate: a systematic review and meta-analysis.

BACKGROUND

Cleft lip and palate (CLP) frequently cause maxillary hypoplasia, requiring surgical advancement, and virtual surgical planning (VSP) is increasingly used to improve accuracy. This systematic review and meta-analysis synthesized the evidence on VSP-assisted maxillary advancement in patients with CLP, with surgical accuracy as the primary outcome and skeletal stability, intraoperative efficiency, complications, patient-reported outcomes, and software utility as the secondary outcomes.

METHODS

This review followed the PRISMA 2020 statement and was prospectively registered (PROSPERO CRD420251011475). PubMed, Scopus, Web of Science, Embase, and ScienceDirect were searched. Methodological quality and certainty of evidence were assessed. Conventional osteotomy and distraction osteogenesis were analyzed separately; an exploratory random-effects meta-analysis was performed only for the homogeneous conventional Le Fort I osteotomy subset.

RESULTS

Twelve studies were included. VSP achieved clinically acceptable accuracy, with mean linear deviations of 0.05-2.75 mm and most angular deviations below 4°. In the conventional Le Fort I subset, random-effects pooling with Hartung-Knapp adjustment gave mean absolute deviations of 0.65 mm mediolaterally (95% CI 0.58-0.73) and 1.10 mm superoinferiorly (0.49-1.71), both highly consistent (I2 = 0%). Anteroposterior deviation was not pooled owing to substantial heterogeneity (I2 = 88%) and ranged from 1.03 to 2.75 mm across studies. Where reported, relapse was generally 1-2 mm but heterogeneous.

CONCLUSION

Current evidence supports the accuracy and feasibility of VSP-assisted maxillary advancement in patients with CLP; however, it is insufficient to prove reduced relapse or superiority over conventional planning. Because certainty is low to very low, VSP should be regarded as a promising adjunct rather than a proven standard of care; adequately powered prospective comparative studies with standardized outcomes are needed.