Conformity of the Actual to the Planned Result in Orthognathic Surgery.
Adolescent
Adult
Anatomic Landmarks
Female
Humans
Image Processing, Computer-Assisted
/ methods
Imaging, Three-Dimensional
/ methods
Jaw Relation Record
/ methods
Male
Mandible
/ surgery
Maxilla
/ surgery
Middle Aged
Orthognathic Surgical Procedures
/ methods
Patient Care Planning
Surgery, Computer-Assisted
/ methods
Young Adult
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
entrez:
28
6
2019
pubmed:
28
6
2019
medline:
29
10
2019
Statut:
ppublish
Résumé
Virtual surgical planning has facilitated preoperative planning, splint accuracy, and intraoperative efficiency in orthognathic surgery. The translation of the virtual surgical plan to the actual result has not been adequately examined. The authors examined the conformity of the virtual surgical plan to the postoperative result. They hypothesize that the greatest conformity exists in the anteroposterior dimensions. The authors examined patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty. The preoperative virtual surgical planning file and postoperative cone beam computed tomographic scan were registered in Mimics using unchanged landmarks. The conformity to the virtual surgical plan was quantified using linear and angular measurements between bone surface landmarks. Results were compared using t tests, with p < 0.05 considered statistically significant RESULTS:: One hundred patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty were included. Three-dimensional analysis showed significant differences between the plan and outcome for the following landmarks: A point (y, p = 0.04; z, p = 0.04), B point (y, p = 0.02; z, p = 0.02), pogonion (y, p = 0.04), menton (x, p = 0.02; y, p = 0.01; z, p = 0.03), and anterior nasal spine (x, p = 0.04; y, p = 0.04; z, p = 0.01). Angular measurements sella-nasion-A point, sella-nasion-B point, and A point-nasion-B point were not statistically different. There is a high degree of conformity comparing the orthognathic virtual surgical plan to the actual postoperative result. However, some incongruency is seen vertically (maxilla) and sagittally (mandible, chin). Departures of the actual position compared with the plan could be the result of condylar position changes, osteotomy locations, aesthetic intraoperative decisions, and/or play in the system.
Sections du résumé
BACKGROUND
Virtual surgical planning has facilitated preoperative planning, splint accuracy, and intraoperative efficiency in orthognathic surgery. The translation of the virtual surgical plan to the actual result has not been adequately examined. The authors examined the conformity of the virtual surgical plan to the postoperative result. They hypothesize that the greatest conformity exists in the anteroposterior dimensions.
METHODS
The authors examined patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty. The preoperative virtual surgical planning file and postoperative cone beam computed tomographic scan were registered in Mimics using unchanged landmarks. The conformity to the virtual surgical plan was quantified using linear and angular measurements between bone surface landmarks. Results were compared using t tests, with p < 0.05 considered statistically significant RESULTS:: One hundred patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty were included. Three-dimensional analysis showed significant differences between the plan and outcome for the following landmarks: A point (y, p = 0.04; z, p = 0.04), B point (y, p = 0.02; z, p = 0.02), pogonion (y, p = 0.04), menton (x, p = 0.02; y, p = 0.01; z, p = 0.03), and anterior nasal spine (x, p = 0.04; y, p = 0.04; z, p = 0.01). Angular measurements sella-nasion-A point, sella-nasion-B point, and A point-nasion-B point were not statistically different.
CONCLUSIONS
There is a high degree of conformity comparing the orthognathic virtual surgical plan to the actual postoperative result. However, some incongruency is seen vertically (maxilla) and sagittally (mandible, chin). Departures of the actual position compared with the plan could be the result of condylar position changes, osteotomy locations, aesthetic intraoperative decisions, and/or play in the system.
Identifiants
pubmed: 31246828
doi: 10.1097/PRS.0000000000005744
pii: 00006534-201907000-00040
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
89e-97eRéférences
Steinbacher DM. Three-dimensional analysis and surgical planning in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2015;73(Suppl):S40–S56.
Panula K, Finne K, Oikarinen K. Incidence of complications and problems related to orthognathic surgery: A review of 655 patients. J Oral Maxillofac Surg. 2001;59:1128–1136; discussion 1137.
Cunningham SJ, Crean SJ, Hunt NP, Harris M. Preparation, perceptions, and problems: A long-term follow-up study of orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 1996;11:41–47.
Wrzosek MK, Peacock ZS, Laviv A, et al. Comparison of time required for traditional versus virtual orthognathic surgery treatment planning. Int J Oral Maxillofac Surg. 2016;45:1065–1069.
Resnick CM, Inverso G, Wrzosek M, Padwa BL, Kaban LB, Peacock ZS. Is there a difference in cost between standard and virtual surgical planning for orthognathic surgery? J Oral Maxillofac Surg. 2016;74:1827–1833.
Xia JJ, Gateno J, Teichgraeber JF, et al. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: Planning sequence. Int J Oral Maxillofac Surg. 2015;44:1431–1440.
Hsu SS, Gateno J, Bell RB, et al. Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: A prospective multicenter study. J Oral Maxillofac Surg. 2013;71:128–142.
Steinhuber T, Brunold S, Gärtner C, Offermanns V, Ulmer H, Ploder O. Is virtual surgical planning in orthognathic surgery faster than conventional planning? A time and workflow analysis of an office-based workflow for single- and double-jaw surgery. J Oral Maxillofac Surg. 2018;76:397–407.
Van Hemelen G, Van Genechten M, Renier L, Desmedt M, Verbruggen E, Nadjmi N. Three-dimensional virtual planning in orthognathic surgery enhances the accuracy of soft tissue prediction. J Craniomaxillofac Surg. 2015;43:918–925.
Stokbro K, Aagaard E, Torkov P, Bell RB, Thygesen T. Virtual planning in orthognathic surgery. Int J Oral Maxillofac Surg. 2014;43:957–965.
Stokbro K, Aagaard E, Torkov P, Bell RB, Thygesen T. Surgical accuracy of three-dimensional virtual planning: A pilot study of bimaxillary orthognathic procedures including maxillary segmentation. Int J Oral Maxillofac Surg. 2016;45:8–18.
Chin SJ, Wilde F, Neuhaus M, Schramm A, Gellrich NC, Rana M. Accuracy of virtual surgical planning of orthognathic surgery with aid of CAD/CAM fabricated surgical splint: A novel 3D analyzing algorithm. J Craniomaxillofac Surg. 2017;45:1962–1970.
De Riu G, Virdis PI, Meloni SM, Lumbau A, Vaira LA. Accuracy of computer-assisted orthognathic surgery. J Craniomaxillofac Surg. 2018;46:293–298.
Martinez AY, Bradrick JP. Y modification of the transconjunctival approach for management of zygomaticomaxillary complex fractures: A technical note. J Oral Maxillofac Surg. 2012;70:97–101.
Xia JJ, Gateno J, Teichgraeber JF, et al. Accuracy of the computer-aided surgical simulation (CASS) system in the treatment of patients with complex craniomaxillofacial deformity: A pilot study. J Oral Maxillofac Surg. 2007;65:248–254.
Farkas LG, Deutsch CK. Anthropometric determination of craniofacial morphology. Am J Med Genet. 1996;65:1–4.
Lin HH, Lo LJ. Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: A literature review. J Formos Med Assoc. 2015;114:300–307.
Wu TY, Lin HH, Lo LJ, Ho CT. Postoperative outcomes of two- and three-dimensional planning in orthognathic surgery: A comparative study. J Plast Reconstr Aesthet Surg. 2017;70:1101–1111.
Hammoudeh JA, Howell LK, Boutros S, Scott MA, Urata MM. Current status of surgical planning for orthognathic surgery: Traditional methods versus 3D surgical planning. Plast Reconstr Surg Glob Open 2015;3:e307.
Ritto FG, Schmitt ARM, Pimentel T, Canellas JV, Medeiros PJ. Comparison of the accuracy of maxillary position between conventional model surgery and virtual surgical planning. Int J Oral Maxillofac Surg. 2018;47:160–166.
Bouchard C, Landry PÉ. Precision of maxillary repositioning during orthognathic surgery: A prospective study. Int J Oral Maxillofac Surg. 2013;42:592–596.
Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: An update and extension. Head Face Med. 2007;3:21.
Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: A hierarchy of stability. Int J Adult Orthodon Orthognath Surg. 1996;11:191–204.
Donatsky O, Bjørn-Jørgensen J, Holmqvist-Larsen M, Hillerup S. Computerized cephalometric evaluation of orthognathic surgical precision and stability in relation to maxillary superior repositioning combined with mandibular advancement or setback. J Oral Maxillofac Surg. 1997;55:1071–1079; discussion 1079–1080.
Tng TT, Chan TC, Hägg U, Cooke MS. Validity of cephalometric landmarks: An experimental study on human skulls. Eur J Orthod. 1994;16:110–120.
Padwa BL, Kaiser MO, Kaban LB. Occlusal cant in the frontal plane as a reflection of facial asymmetry. J Oral Maxillofac Surg. 1997;55:811–816; discussion 817.
Polido WD, Ellis E III, Sinn DP. An assessment of the predictability of maxillary surgery. J Oral Maxillofac Surg. 1990;48:697–701.
Sun Y, Luebbers HT, Agbaje JO, et al. Accuracy of upper jaw positioning with intermediate splint fabrication after virtual planning in bimaxillary orthognathic surgery. J Craniofac Surg. 2013;24:1871–1876.
Gil JN, Campos FE, Claus JD, Gil LF, Marin C, de Freitas SF. Medial canthal region as an external reference point in orthognathic surgery. J Oral Maxillofac Surg. 2011;69:352–355.
Borba AM, Borges AH, Cé PS, Venturi BA, Naclério-Homem MG, Miloro M. Mandible-first sequence in bimaxillary orthognathic surgery: A systematic review. Int J Oral Maxillofac Surg. 2016;45:472–475.
Cottrell DA, Wolford LM. Altered orthognathic surgical sequencing and a modified approach to model surgery. J Oral Maxillofac Surg. 1994;52:1010–1020; discussion 1020–1021.
Ritto FG, Ritto TG, Ribeiro DP, Medeiros PJ, de Moraes M. Accuracy of maxillary positioning after standard and inverted orthognathic sequencing. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117:567–574.
Bamber MA, Abang Z, Ng WF, Harris M, Linney A. The effect of posture and anesthesia on the occlusal relationship in orthognathic surgery. J Oral Maxillofac Surg. 1999;57:1164–1172; discussion 1172–1174.
Yaghmaei M, Ejlali M, Nikzad S, Sayyedi A, Shafaeifard S, Pourdanesh F. General anesthesia in orthognathic surgeries: Does it affect horizontal jaw relations? J Oral Maxillofac Surg. 2013;71:1752–1756.
Borba AM, Ribeiro-Junior O, Brozoski MA, et al. Accuracy of perioperative mandibular positions in orthognathic surgery. Int J Oral Maxillofac Surg. 2014;43:972–979.