Use of Technology to Facilitate Complex Craniofacial Trauma Reconstruction I: Concepts and Case Reviews

Background: Virtual surgical planning (VSP) with operative deliverables (eg, guides, plates) is well-established in elective craniomaxillofacial procedures like orthognathic surgery, enhancing surgical accuracy and efficiency. However, its application in acute craniofacial trauma has been limited by logistical challenges such as time constraints, transport, cost, and concerns about model accuracy. Objective: To describe a protocol incorporating preoperative VSP and intraoperative plate-bending/etching using 3D-printed templates for acute craniofacial fracture repair, assessing its practical utility. Methods: A retrospective review was conducted on patients treated surgically for craniomaxillofacial trauma between January 1, 2020, and January 1, 2025. Three representative cases were selected to illustrate the VSP with operative deliverables (VSPD) protocol. Key data included demographics, injuries, treatments, complications, and reoperations. The VSPD protocol begins with craniofacial CT imaging (1 mm cuts) at admission, followed by a VSP session typically within 48 hours to virtually reduce fractures and design 3D models and occlusal splints. These can be printed and delivered within another 48 hours. Intraoperatively, plates are pre-bent to the reduced model and etched along fracture lines for precise alignment. Results: In the 3 cases presented, the VSPD protocol subjectively improved surgical accuracy, intraoperative workflow, and efficiency. No hardware or postoperative complications were observed. Delay in treatment over 72 hours of craniomaxillofacial fractures, including open mandible fractures, did not lead to an increased rate of postoperative infection. We observed a strong visual correlation of postoperative scans with VSP plans. Conclusion: Obtaining accurate results in facial fracture treatment with efficiency is challenging. Use of our VSPD protocol for the treatment of complex craniofacial fractures was successfully applied to treat patients. Reduction/perfection models marked with fracture sites and occlusal splints were useful for transferring the virtual plan surgically, improving understanding of the 3D skeleton, operative workflow, and accuracy in complex facial fracture repair.