Virtual Surgical Simulation (VSS) an Underutilized Resident Training Tool in Craniomaxillofacial Surgery

Background: Virtual surgical planning (VSP) has enhanced craniomaxillofacial surgery by improving precision and predictability. However, resident exposure to VSP during training remains limited. We hypothesize that even 1 VSP simulation session will enhance the plastic surgery residents’ understanding of the VSP process and improve their understanding of 3-dimensional osteotomy planning. Methods: In a prospective educational study, 6 plastic surgery residents (PGY 2-5) participated in a virtual surgical planning simulation using a deidentified CT scan. Residents were instructed to guide the VSP technician to perform osteotomies with the aim of reducing both the vertical and horizontal dimensions of the subject’s chin. During the osteotomy simulation, the model and view were limited to what would be visible intraoperatively. Once the osteotomies were performed, a full 3-D view of the skull was presented and residents had an opportunity to perform additional osteotomies if desired. Pre- and post-simulation surveys assessed confidence, understanding, and perceptions of VSP as an educational tool. Primary outcome was identification and correction of inadequate vertical height reduction involving the mandibular spine. Results: Prior to the simulation, median confidence in performing reductive genioplasty was low (2/5), with limited familiarity with VSP. During the initial simulation, 83% of residents failed to address the mandibular spine and thereby 3-dimensional vertical height reduction. All recognized and corrected their mistakes after full 3D model rotation. Post-simulation, confidence to use VSP increased by 20% (median 3/5). The simulation was well received, with 83% reporting improved understanding and a median satisfaction score of 4/5. The likelihood of recommending VSP simulation to colleagues was high (median 5/5). Conclusion: VSP simulation improves resident confidence in simple osteotomy planning. Incorporating VSP into surgical education provides a reproducible, low-risk environment for skill acquisition and may enhance intraoperative performance and understanding. Residency programs should integrate VSP simulation sessions into the educational curriculum.