Transoral robotic surgery in maxillofacial surgery: Systematic review of literature on current situation and future perspectives

Abstract

Transoral robotic surgery (TORS) is a robotically assisted surgery performed through the oral cavity. The approach effectiveness has already been demonstrated for otorhinolaryngological pathologies; the aim of this study was to perform a systematic review on TORS role in maxillofacial surgery, in particular to take stock of the situation for hard tissues diseases management. The literature research was conducted using different databases: PubMed, Web of Sciences, MEDLINE, Embase, Scopus, Google Scholar and Cochrane Library. The following keywords were used for the literature research: “transoral robotic surgery” OR “TORS” AND “maxillofacial surgery” OR “face”. Studies selection was performed following PRISMA statement. Data extracted from the selected studies were about type of study, country, number of cases, field of application of TORS, robot type, treated disease, surgical operative time, outcomes and complications. 38 studies were included in the systematic review, analyzing in total 3630 procedures. Most of articles (28.9%) described Obstructive sleep apnea correction procedures, but the higher success rate was recorded for submandibular sialoadenectomy (94%). The most experienced complications were transient lingual nerve disorders with dysgeusia/hypogeusia (13.3%) and dysphagia (7.4%). Among the included papers, no articles analyzed hard tissue experience; the only hard tissue studies were done on animals or phantoms Data obtained confirm that TORS is a valid tool for treatment of head&neck soft tissue pathologies, also of maxillofacial pertinence. The effectiveness on the hard tissues is still being studied, but the most promising results have been obtained for orthognathic surgery and implantology.