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Development and refinement of computer-assisted planning and execution system for use in face-jaw-teeth transplantation to improve skeletal and dento-occlusal outcomes. Curr Opin Organ Transplant 2017; 21:523-9. [PMID: 27517508 DOI: 10.1097/mot.0000000000000350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe the development and refinement of the computer-assisted planning and execution (CAPE) system for use in face-jaw-teeth transplants (FJTTs). RECENT FINDINGS Although successful, some maxillofacial transplants result in suboptimal hybrid occlusion and may require subsequent surgical orthognathic revisions. Unfortunately, the use of traditional dental casts and splints pose several compromising shortcomings in the context of FJTT and hybrid occlusion. Computer-assisted surgery may overcome these challenges. Therefore, the use of computer-assisted orthognathic techniques and functional planning may prevent the need for such revisions and improve facial-skeletal outcomes. SUMMARY A comprehensive CAPE system for use in FJTT was developed through a multicenter collaboration and refined using plastic models, live miniature swine surgery, and human cadaver models. The system marries preoperative surgical planning and intraoperative execution by allowing on-table navigation of the donor fragment relative to recipient cranium, and real-time reporting of patient's cephalometric measurements relative to a desired dental-skeletal outcome. FJTTs using live-animal and cadaveric models demonstrate the CAPE system to be accurate in navigation and beneficial in improving hybrid occlusion and other craniofacial outcomes. Future refinement of the CAPE system includes integration of more commonly performed orthognathic/maxillofacial procedures.
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202
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Miloro M, Markiewicz MR. Virtual Surgical Planning for Inferior Alveolar Nerve Reconstruction. J Oral Maxillofac Surg 2017; 75:2442-2448. [DOI: 10.1016/j.joms.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
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203
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Ramos V, Pinto L, Basting R. Force and deformation stresses in customized and non-customized plates during simulation of advancement genioplasty. J Craniomaxillofac Surg 2017; 45:1820-1827. [DOI: 10.1016/j.jcms.2017.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 07/16/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022] Open
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204
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Zhang X, Kim D, Shen S, Yuan P, Liu S, Tang Z, Zhang G, Zhou X, Gateno J, Liebschner MAK, Xia JJ. An eFTD-VP framework for efficiently generating patient-specific anatomically detailed facial soft tissue FE mesh for craniomaxillofacial surgery simulation. Biomech Model Mechanobiol 2017; 17:387-402. [PMID: 29027022 DOI: 10.1007/s10237-017-0967-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Abstract
Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians' need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical simulation of facial soft tissue change.
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Affiliation(s)
- Xiaoyan Zhang
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, China
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Peng Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Siting Liu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Zhen Tang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Guangming Zhang
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Xiaobo Zhou
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jaime Gateno
- Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College of Cornell University, New York, NY, USA
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Michael A K Liebschner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA.
| | - James J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th Peoples Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College of Cornell University, New York, NY, USA.
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA.
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205
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Cousley RRJ, Bainbridge M, Rossouw PE. The accuracy of maxillary positioning using digital model planning and 3D printed wafers in bimaxillary orthognathic surgery. J Orthod 2017; 44:256-267. [PMID: 28980512 DOI: 10.1080/14653125.2017.1383708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Orthognathic wafers may be made using digital model movements and CAD-CAM technology. This paper analysed the accuracy of maxillary movements using this new process. DESIGN Retrospective study of pre and post-operative cephalograms. PARTICIPANTS Thirty consecutive orthognathic patients undergoing bimaxillary osteotomies in a UK hospital. METHODS Jaw movements were planned using cephalometric and Orthoanalyzer™ software. The resultant intermediate and final wafer occlusal relationships were used for wafer fabrication by 3D printing of the inter-occlusal space. Pre- and post-operative lateral cephalograms were compared in terms of maxillary antero-posterior and vertical movements. Statistical analyses including the paired t-test, two-sample t-test and Fisher's exact test. RESULTS Wide individual variation was observed between the planned and actual movements. Thirteen cases (43%) had a 2 mm discrepancy in at least one variable. Statistically significant differences between the planned and actual maxillary vertical movements were observed for the molar (U6y: p < 0.0001) and anterior maxillary (Ay: p < 0.01) differences. Analysis of a subgroup with primarily impaction movements demonstrated a statistically significant bias towards excessive maxillary advancement (U1x: p < 0.01) and incisor impaction (U1y: p < 0.01) in this group. CONCLUSIONS This new digital surgical wafer technique achieves a similar level of accuracy to the conventional facebow and model surgery process.
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Affiliation(s)
- Richard R J Cousley
- a Orthodontic Department , Peterborough and Stamford Hospitals NHS Foundation Trust , Peterborough , UK
| | - Mark Bainbridge
- a Orthodontic Department , Peterborough and Stamford Hospitals NHS Foundation Trust , Peterborough , UK
| | - P Emile Rossouw
- b Division of Orthodontics and Dentofacial Orthopedics , University of Rochester, Eastman Institute of Oral Health , Rochester , NY , USA
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206
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Enhanced Surgical Outcomes in Patients With Skeletal Class III Facial Asymmetry by 3-Dimensional Surgical Simulation. J Oral Maxillofac Surg 2017; 76:1073-1083. [PMID: 29031529 DOI: 10.1016/j.joms.2017.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE With the advance of image fusion techniques, the creation of 3-dimensional (3D) virtual head and 3D surgical simulations has provided previews of surgical procedures. The aim of this study was to investigate the surgical outcomes in patients receiving orthognathic surgery (OGS) with the guidance of 3D computer-assisted surgical simulation. PATIENTS AND METHODS The study included 34 consecutive patients (15 men and 19 women; age, 18.1 to 33.0 yr) with skeletal Class III facial asymmetry who underwent bimaxillary OGS. One-week postoperative cone-beam computed tomographic craniofacial images (Ta) were constructed and superimposed on preoperative simulated virtual images (Ts) at the cranial base and surfaces of the frontal and periorbital regions. The 3D cephalometric landmarks were measured relative to 3 reference planes. The outcomes among different experience levels of surgeons also were compared. RESULTS Although the mean values between Ta and Ts were small, statistical differences were observed in the center of maxillary and mandibular incisors and the B point relative to the midline and in the maxillary first molar in vertical distances, sagittal dentoskeletal dimensions, and pitch angles. The root mean square deviations (RMSDL) of measurement variables relative to center landmark accuracy were 1.5 and less than 2 mm at the maxilla and mandible, respectively. RMSDL greater than 2 mm was located at the maxillary first molar in the vertical distance and in the sagittal dimension at the anterior nasal spine and B point. Variables related to centering the midline structures were highly inter-related. The roll angle deviation was associated with centering the midline landmarks. The yaw angle deviation was not associated with midline correction. CONCLUSION With guidance from 3D surgical simulation, surgeons could achieve similar outcomes to correct facial asymmetry regardless of their years of practice.
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207
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Bengtsson M, Wall G, Greiff L, Rasmusson L. Treatment outcome in orthognathic surgery—A prospective randomized blinded case-controlled comparison of planning accuracy in computer-assisted two- and three-dimensional planning techniques (part II). J Craniomaxillofac Surg 2017; 45:1419-1424. [DOI: 10.1016/j.jcms.2017.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/24/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022] Open
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208
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Heufelder M, Wilde F, Pietzka S, Mascha F, Winter K, Schramm A, Rana M. Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery. J Craniomaxillofac Surg 2017; 45:1578-1585. [DOI: 10.1016/j.jcms.2017.06.027] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 11/25/2022] Open
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209
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Yiasemidou M, Galli R, Glassman D, Tang M, Aziz R, Jayne D, Miskovic D. Patient-specific mental rehearsal with interactive visual aids: a path worth exploring? Surg Endosc 2017; 32:1165-1173. [PMID: 28840324 PMCID: PMC5807505 DOI: 10.1007/s00464-017-5788-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 11/06/2022]
Abstract
Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors. Results The participants performed equally well when presented with a “straight-forward” anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η2 = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η2 = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η2=0.34, DA: 0 vs. 1 p = 0.02 η2 = 0.22). in the cases with more challenging anatomies. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - Raffaele Galli
- John Goligher Surgery Unit, St. James University Hospital, Leeds, UK
| | | | | | - Rahoz Aziz
- Medical School, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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210
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Liebregts J, Baan F, de Koning M, Ongkosuwito E, Bergé S, Maal T, Xi T. Achievability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery. Sci Rep 2017; 7:9314. [PMID: 28839184 PMCID: PMC5571157 DOI: 10.1038/s41598-017-09488-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/27/2017] [Indexed: 11/09/2022] Open
Abstract
The present study was aimed to investigate the effects of sequencing a two-component surgical procedure for correcting malpositioned jaws (bimaxillary osteotomies); specifically, surgical repositioning of the upper jaw-maxilla, and the lower jaw-mandible. Within a population of 116 patients requiring bimaxillary osteotomies, the investigators analyzed whether there were statistically significant differences in postoperative outcome as measured by concordance with a preoperative digital 3D virtual treatment plan. In one group of subjects (n = 58), the maxillary surgical procedure preceded the mandibular surgery. In the second group (n = 58), the mandibular procedure preceded the maxillary surgical procedure. A semi-automated analysis tool (OrthoGnathicAnalyser) was applied to assess the concordance of the postoperative maxillary and mandibular position with the cone beam CT-based 3D virtual treatment planning in an effort to minimize observer variability. The results demonstrated that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. In selected circumstances, such as a planned counterclockwise rotation of both jaws, the mandible-first sequence resulted in more predictable displacements of the jaws.
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Affiliation(s)
- Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Edwin Ongkosuwito
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Philips van Leydenlaan 25, 6525, EX, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands.
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211
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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. [DOI: 10.1016/j.bjps.2017.04.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/14/2017] [Indexed: 11/30/2022]
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212
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Wang L, Tian D, Sun X, Xiao Y, Chen L, Wu G. The Precise Repositioning Instrument for Genioplasty and a Three-Dimensional Printing Technique for Treatment of Complex Facial Asymmetry. Aesthetic Plast Surg 2017; 41:919-929. [PMID: 28409207 DOI: 10.1007/s00266-017-0875-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Facial asymmetry is very common in maxillofacial deformities. It is difficult to achieve accurate reconstruction. With the help of 3D printing models and surgical templates, the osteotomy line and the amount of bone grinding can be accurate. Also, by means of the precise repositioning instrument, the repositioning of genioplasty can be accurate and quick. In this study, we present a three-dimensional printing technique and the precise repositioning instrument to guide the osteotomy and repositioning, and illustrate their feasibility and validity. METHODS Eight patients with complex facial asymmetries were studied. A precise 3D printing model was obtained. We made the preoperative design and surgical templates according to it. The surgical templates and precise repositioning instrument were used to obtain an accurate osteotomy and repositioning during the operation. Postoperative measurements were made based on computed tomographic data, including chin point deviation as well as the symmetry of the mandible evaluated by 3D curve functions. RESULTS All patients obtained satisfactory esthetic results, and no recurrences occurred during follow-up. The results showed that we achieved clinically acceptable precision for the mandible and chin. The mean and SD of ICC between R-Post and L-Post were 0.973 ± 0.007. The mean and SD of chin point deviation 6 months after the operation were 0.63 ± 0.19 mm. CONCLUSION The results of this study suggest that the three-dimensional printing technique and the precise repositioning instrument could aid in making better operation designs and more accurate manipulation in orthognathic surgery for complex facial asymmetry. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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213
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Cottrell DA, Farrell B, Ferrer-Nuin L, Ratner S. Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2017; 75:e94-e125. [DOI: 10.1016/j.joms.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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214
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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. [PMID: 29066041 DOI: 10.1016/j.jcms.2017.07.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/31/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022] Open
Abstract
The benefit of computer-assisted planning in orthognathic surgery has been extensively documented over the last decade. This study aims to evaluate the accuracy of a virtual orthognathic surgical plan by a novel three dimensional (3D) analysis method. Ten patients who required orthognathic surgery were included in this study. A virtual surgical plan was achieved by the combination of a 3D skull model acquired from computed tomography (CT) and surface scanning of the upper and lower dental arch respectively and final occlusal position. Osteotomies and movement of maxilla and mandible were simulated by Dolphin Imaging 11.8 Premium® (Dolphin Imaging and Management Solutions, Chatsworth, CA). The surgical plan was transferred to surgical splints fabricated by means of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM). Differences of three dimensional measurements between the virtual surgical plan and postoperative results were evaluated. The results from all parameters showed that the virtual surgical plans were successfully transferred by the assistance of CAD/CAM fabricated surgical splint. Wilcoxon's signed rank test showed that no statistically significant deviation between surgical plan and post-operational result could be detected. However, deviation of angle U1 axis-HP and distance of A-CP could not fulfill the clinical success criteria. Virtual surgical planning and CAD/CAM fabricated surgical splint are proven to facilitate treatment planning and offer an accurate surgical result in orthognathic surgery.
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Affiliation(s)
- Shih-Jan Chin
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany
| | - Frank Wilde
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany
| | - Michael Neuhaus
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany
| | - Alexander Schramm
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital Ulm and Academic Hospital University, Ulm, Germany
| | | | - Majeed Rana
- Department of Craniomaxillofacial Surgery, Hannover Medical School, Germany.
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215
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Application of A Novel Three-dimensional Printing Genioplasty Template System and Its Clinical Validation: A Control Study. Sci Rep 2017; 7:5431. [PMID: 28710459 PMCID: PMC5511285 DOI: 10.1038/s41598-017-05417-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/30/2017] [Indexed: 11/08/2022] Open
Abstract
The purpose of this control study was to assess the accuracy and clinical validation of a novel genioplasty template system. Eighty-eight patients were enrolled and divided into 2 groups: experimental group (using genioplasty templates) and control group (without genioplasty templates). For the experimental group, the templates were designed based on computerized surgical plan and manufactured using three-dimensional printing technique. The template system included a cutting guide and a pair of repositioning guides. For the control group, traditional intraoperative measurements were used without genioplasty templates. The outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. Linear and angular differences for the chin was measured and reported using root mean square deviation (RMSD) and the Bland-Altman method. All surgeries were successfully completed. There was no difficulty to use genioplasty templates. For the experimental group, the largest RMSDs were 1.1 mm in anteroposterior direction and 2.6° in pitch orientation. For the control group without templates, the largest RMSDs were 2.63 mm in superoinferior direction and 7.21° in pitch orientation. Our findings suggest that this genioplasty template system provides greater accuracy in repositioning the chin than traditional intraoperative measurements, and the computerized plan can be transferred accurately to the patient for genioplasty.
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216
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Kim D, Ho DCY, Mai H, Zhang X, Shen SGF, Shen S, Yuan P, Liu S, Zhang G, Zhou X, Gateno J, Liebschner MAK, Xia JJ. A clinically validated prediction method for facial soft-tissue changes following double-jaw surgery. Med Phys 2017; 44:4252-4261. [PMID: 28570001 DOI: 10.1002/mp.12391] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE It is clinically important to accurately predict facial soft-tissue changes prior to orthognathic surgery. However, the current simulation methods are problematic, especially in anatomic regions of clinical significance, e.g., the nose, lips, and chin. We developed a new 3-stage finite element method (FEM) approach that incorporates realistic tissue sliding to improve such prediction. METHODS In Stage One, soft-tissue change was simulated, using FEM with patient-specific mesh models generated from our previously developed eFace template. Postoperative bone movement was applied on the patient mesh model with standard FEM boundary conditions. In Stage Two, the simulation was improved by implementing sliding effects between gum tissue and teeth using a nodal force constraint scheme. In Stage Three, the result of the tissue sliding effect was further enhanced by reassigning the soft-tissue-bone mapping and boundary conditions using nodal spatial constraint. Finally, our methods have been quantitatively and qualitatively validated using 40 retrospectively evaluated patient cases by comparing it to the traditional FEM method and the FEM with sliding effect, using a nodal force constraint method. RESULTS The results showed that our method was better than the other two methods. Using our method, the quantitative distance errors between predicted and actual patient surfaces for the entire face and any subregions thereof were below 1.5 mm. The overall soft-tissue change prediction was accurate to within 1.1 ± 0.3 mm, with the accuracy around the upper and lower lip regions of 1.2 ± 0.7 mm and 1.5 ± 0.7 mm, respectively. The results of qualitative evaluation completed by clinical experts showed an improvement of 46% in acceptance rate compared to the traditional FEM simulation. More than 80% of the result of our approach was considered acceptable in comparison with 55% and 50% following the other two methods. CONCLUSION The FEM simulation method with improved sliding effect showed significant accuracy improvement in the whole face and the clinically significant regions (i.e., nose and lips) in comparison with the other published FEM methods, with or without sliding effect using a nodal force constraint. The qualitative validation also proved the clinical feasibility of the developed approach.
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Affiliation(s)
- Daeseung Kim
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Dennis Chun-Yu Ho
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Huaming Mai
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Xiaoyan Zhang
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Steve G F Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China
| | - Peng Yuan
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Siting Liu
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA
| | - Guangming Zhang
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Xiaobo Zhou
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Jaime Gateno
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA.,Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, 10065, USA
| | | | - James J Xia
- Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, TX, 77030, USA.,Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, 200011, China.,Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, 10065, USA
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Agbaje JO, Sun Y, Salem AS, Li Z, Adu KO, Politis C. Achieved chin position after genioplasty follows the planned horizontal change better than the planned vertical change. J Craniomaxillofac Surg 2017; 45:1287-1292. [PMID: 28684075 DOI: 10.1016/j.jcms.2017.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The soft-tissue pogonion closely follows changes of the bony pogonion, but it is unknown how often an augmented bony pogonion reaches the intended position. Here we assessed the agreement between planned surgical changes and achieved results in chin surgery. MATERIALS AND METHODS Surgical treatment was planned based on clinical examination, cast model analysis, and cephalometric image analysis. The mobile chin segment was stabilized using one chin plate. Preoperative and postoperative cephalometric X-ray images were digitized, and cephalometric tracing was performed. We calculated and analyzed the changes between the preoperative and postoperative images as well as between planned genioplasty movements and actual surgical changes in the horizontal and vertical directions. RESULTS This study included 36 patients. In 34 patients, the absolute mean horizontal difference was less than 2 mm. We found a higher range of absolute error in vertical (0.00-5.60) compared to horizontal (0.01-3.64) movement. There was no significant difference between the mean planned chin movement and the mean achieved position with regard to the horizontal and vertical movement (p = 0.97 and 0.79, respectively). CONCLUSIONS The mean values for linear difference in both the horizontal and vertical directions were in line with the acceptable mean of ≤2 mm proposed in the literature.
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Affiliation(s)
- Jimoh Olubanwo Agbaje
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium.
| | - Yi Sun
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium
| | - Ahmed S Salem
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium; Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Zhaokai Li
- Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
| | - Kelvin Osei Adu
- Kwame Nkrumah University of Science & Technology Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium; Faculty of Medicine, Hasselt University, Diepenbeek, Belgium
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Gaber RM, Shaheen E, Falter B, Araya S, Politis C, Swennen GRJ, Jacobs R. A Systematic Review to Uncover a Universal Protocol for Accuracy Assessment of 3-Dimensional Virtually Planned Orthognathic Surgery. J Oral Maxillofac Surg 2017. [PMID: 28646644 DOI: 10.1016/j.joms.2017.05.025] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to systematically review methods used for assessing the accuracy of 3-dimensional virtually planned orthognathic surgery in an attempt to reach an objective assessment protocol that could be universally used. MATERIALS AND METHODS A systematic review of the currently available literature, published until September 12, 2016, was conducted using PubMed as the primary search engine. We performed secondary searches using the Cochrane Database, clinical trial registries, Google Scholar, and Embase, as well as a bibliography search. Included articles were required to have stated clearly that 3-dimensional virtual planning was used and accuracy assessment performed, along with validation of the planning and/or assessment method. Descriptive statistics and quality assessment of included articles were performed. RESULTS The initial search yielded 1,461 studies. Only 7 studies were included in our review. An important variability was found regarding methods used for 1) accuracy assessment of virtually planned orthognathic surgery or 2) validation of the tools used. Included studies were of moderate quality; reviewers' agreement regarding quality was calculated to be 0.5 using the Cohen κ test. CONCLUSIONS On the basis of the findings of this review, it is evident that the literature lacks consensus regarding accuracy assessment. Hence, a protocol is suggested for accuracy assessment of virtually planned orthognathic surgery with the lowest margin of error.
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Affiliation(s)
- Ramy M Gaber
- Assistant Lecturer and Doctoral Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt, and Research Fellow, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical engineer, OMFS-IMPATH research group, Department of Imaging and Pathology, Catholic University of Leuven & Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Bart Falter
- Consultant, Department of Oral and Maxillofacial Surgery, University Hospital of Leuven, Leuven, Belgium
| | | | - Constantinus Politis
- Professor and Head, Department of Oral and Maxillofacial Surgery, Catholic University of Leuven, Leuven, Belgium
| | - Gwen R J Swennen
- Professor, Maxillofacial and Facial Plastic Surgery, Department of Surgery, Cleft and Craniofacial Centre, Bruges, Belgium, and Three-Dimensional Facial Imaging Research Group, General Hospital St Jan, Bruges, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
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Stokbro K, Aagaard E, Torkov P, Marcussen L, Bell RB, Thygesen T. Surgical Splint Design Influences Transverse Expansion in Segmental Maxillary Osteotomies. J Oral Maxillofac Surg 2017; 75:1249-1256. [DOI: 10.1016/j.joms.2016.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/28/2016] [Accepted: 12/28/2016] [Indexed: 11/26/2022]
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Li B, Shen S, Jiang W, Li J, Jiang T, Xia JJ, Shen SG, Wang X. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study. Int J Oral Maxillofac Surg 2017; 46:1298-1305. [PMID: 28552440 DOI: 10.1016/j.ijom.2017.03.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 10/15/2016] [Accepted: 03/20/2017] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74mm and 1.93° for the maxillary dental arch, 1.10mm and 2.82° for the mandibular arch, 0.83mm and 2.59° for the mandibular body, and 0.98mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - W Jiang
- Clinical Translation R&D Center of 3D Printing Technology, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - T Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute for Academic Medicine, Houston Methodist Hospital, Texas, USA; Weill Medical College, Cornell University, New York, NY, USA
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai, China.
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221
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Li J, Yuan P, Chang CM, Ho DCY, Lo YF, Shen S, Kim D, Teichgraeber JF, Alfi DM, Gateno J, Xia JJ. New approach to establish an object reference frame for dental arch in computer-aided surgical simulation. Int J Oral Maxillofac Surg 2017; 46:1193-1200. [PMID: 28499508 DOI: 10.1016/j.ijom.2017.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/06/2017] [Accepted: 04/13/2017] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to develop a principal component analysis-based adaptive minimum Euclidean distances (PAMED) approach to establish an optimal object reference frame for symmetrical alignment of the dental arch during computer-aided surgical simulation (CASS). It was compared with our triangular methods and the standard principal component analysis (PCA) method. Thirty sets of maxillary digital models were used. Midsagittal and occlusal planes were ranked by three experienced evaluators based on their clinical judgment. The results showed that for the midsagittal plane, all three evaluators ranked "ideal" for all 30 models with the PAMED method, 28 with the triangular method, and at least 11 with the PCA method. For the occlusal plane, one evaluator ranked all 30 models "ideal" with both the PAMED and the PCA methods while the other two evaluators ranked all 30 models "ideal" with the triangular method. However, the differences among the three methods were minimal. In conclusion, our PAMED method is the most reliable and consistent approach for establishing the object reference frame for the dental arch in orthognathic surgical planning. The triangular method should be used with caution because it can be affected by dental arch asymmetry. The standard PCA method is not recommended.
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Affiliation(s)
- J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - P Yuan
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - C-M Chang
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - D C-Y Ho
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, Taipei Municipal Wan Fang Hospital, Taipei, Taiwan, ROC
| | - Y-F Lo
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - S Shen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory Stomatology, Shanghai, China
| | - D Kim
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J F Teichgraeber
- Department of Pediatric Surgery, The University of Texas Houston Health Science Center, Houston, TX, USA
| | - D M Alfi
- Department of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, USA; Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - J Gateno
- Department of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, USA; Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - J J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Clinical Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY, USA; Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.
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Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning. Int J Comput Assist Radiol Surg 2017; 12:2129-2143. [PMID: 28432489 DOI: 10.1007/s11548-017-1585-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. METHODS The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. RESULT When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. CONCLUSION We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.
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García y Sánchez JM, Romero Flores J, Gómez Rodríguez CL, Pacheco Rubio G, Rosales Díaz Mirón D, Hernández Miranda A. "Modified Oblique Le Fort III Osteotomy" New Concepts. J Maxillofac Oral Surg 2017; 16:22-42. [PMID: 28286382 PMCID: PMC5328863 DOI: 10.1007/s12663-016-0893-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/18/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The purpose of this study is to demonstrate the surgical technique for the correction of midfacial deformities; vertical excess and posteroanterior hypoplasia. This situation obligates the need to move the whole osseous structure in an oblique posteroanterior movement that should correct both midfacial deformities. This should also correct the lip incompetence while improving the malar projection on a profile view of the patient. We also present a mathematical formula that gives the angulation needed for moving the midface complex in a simultaneous vertical and posteroanterior direction. Once given the correct angulation for the desired oblique movement, the surgeon can reproduce this angulation with custom made surgical guides over the stereolithographic model, that can then be used during surgery to achieve the desired movement accurately. This technique exemplified on this paper will give maxillofacial surgeons a new and affordable tool for the correction of midfacial deformities in an accurate and easily reproducible manner and amplifying the surgical repertoire. MATERIALS AND METHODS Patients seen in the specialty hospital "Dr. Bernardo Sepulveda" National Medical Center XXI Century, IMSS, during the period from February 2013 to November 2014 with Modified Oblique Le Fort III osteotomies, with the application of two trigonometric formulas for the accuracy of the technique. CONCLUSIONS The application of the formulas give accurate results as well as the enlargement of the upper airway and esthetic results.
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Affiliation(s)
- J. M. García y Sánchez
- Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, IMSS, Avenida Cuahtemoc, #330, Colonia Doctores, Mexico, Distrito Federal Mexico
| | - J. Romero Flores
- Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, IMSS, Avenida Cuahtemoc, #330, Colonia Doctores, Mexico, Distrito Federal Mexico
| | - C. L. Gómez Rodríguez
- Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, IMSS, Avenida Cuahtemoc, #330, Colonia Doctores, Mexico, Distrito Federal Mexico
| | - G. Pacheco Rubio
- Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, IMSS, Avenida Cuahtemoc, #330, Colonia Doctores, Mexico, Distrito Federal Mexico
| | - D. Rosales Díaz Mirón
- Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, IMSS, Avenida Cuahtemoc, #330, Colonia Doctores, Mexico, Distrito Federal Mexico
| | - A. Hernández Miranda
- Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, IMSS, Avenida Cuahtemoc, #330, Colonia Doctores, Mexico, Distrito Federal Mexico
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Han L, Long T, Tang W, Liu L, Jing W, Tian WD, Long J. Correlation between Condylar Fracture Pattern after Parasymphyseal Impact and Condyle Morphological Features: A Retrospective Analysis of 107 Chinese Patients. Chin Med J (Engl) 2017; 130:420-427. [PMID: 28218215 PMCID: PMC5324378 DOI: 10.4103/0366-6999.199836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The treatment of the condylar fractures is difficult. Factors that result in the fractures are complex. The objective of this morphometric study was to investigate the relationship between condylar fracture patterns and condylar morphological characteristics. Methods: We conducted a retrospective analysis of 107 patients admitted to the West China Hospital of Stomatology for bilateral condylar fractures caused by parasymphyseal impact. The patients were divided into five groups according to the type of condylar fracture. Ten parameters were evaluated on three-dimensional (3D) reconstruction mandible models through the Mimics 16.0 (Materialize Leuven, Belgium) anthropometry toolkit. Each parameter of the 3D models was analyzed using multivariate analysis. Multinomial logistic regression analyses were used to examine the relationships between the five groups. Results: The results showed that the differences of condylar head width (M1), condylar neck width (M3), the ratio of condylar head width to condylar anteroposterior diameter (M1/M2), the ratio of condylar head width to condylar neck width (M1/M3), the ratio of condylar height to ramus height (M8/M7), and mandibular angle (M10) were statistically significant (p < 0.05). Type A condylar head fractures were positively associated with M1 (compared to Type B: OR =1.627, 95% CI: 1.123, 2.359; compared to Type C: OR = 1.705, 95% CI: 1.170, 2.484) and M1/M2 (compared to Type B: OR =1.034, 95% CI: 0.879, 2.484). Type B condylar head fractures were negatively associated with M10 (compared to Type C: OR = 0.909, 95% CI: 0.821, 1.007). Condylar neck fractures were negatively associated with M3 (compared to condylar head: OR = 0.382, CI: 0.203, 0.720; compared to condylar base: OR = 0.436, 95% CI: 0.218, 0.874), and positively associated with M1/M3 (compared to condylar head: OR = 1.229, 95% CI: 1.063, 1.420 compared to condylar base: OR = 1.223, 95% CI: 1.034, 1.447). Condylar base fractures were positively associated with M10 (OR = 1.095, 95% CI: 1.008, 1.189) and negatively associated with M8/M7 (OR = 0.855, 95% CI: 0.763, 0.959) as compared with condylar head fractures. Conclusions: Condylar fracture pattern is associated with the anatomical features of the condyles when a fracture occurs from parasymphyseal impact.
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Affiliation(s)
- Lu Han
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, Sichuan 610041; Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ting Long
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wei Tang
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lei Liu
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wei Jing
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wei-Dong Tian
- Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jie Long
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, Sichuan 610041; Department of Oral and Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
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Azarmehr I, Stokbro K, Bell RB, Thygesen T. Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2017; 75:1987-2005. [PMID: 28193444 DOI: 10.1016/j.joms.2017.01.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/26/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications are discussed. MATERIALS AND METHODS A systematic search in relevant electronic databases, journals, and bibliographies of the included articles was carried out. Clinical studies with 5 or more patients published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal were the areas of interests. RESULTS The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. CONCLUSIONS SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve.
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Affiliation(s)
- Iman Azarmehr
- Resident, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark.
| | - Kasper Stokbro
- Resident, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - R Bryan Bell
- Director, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center; Attending Surgeon, Trauma Service, Legacy Emanuel Medical Center; and Consultant, Head and Neck Institute, Portland, OR
| | - Torben Thygesen
- Head of Department, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
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Improved Temporomandibular Joint Position After 3-Dimensional Planned Mandibular Reconstruction. J Oral Maxillofac Surg 2017; 75:197-206. [DOI: 10.1016/j.joms.2016.07.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022]
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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 2016; 44:1431-40. [PMID: 26573562 DOI: 10.1016/j.ijom.2015.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022]
Abstract
The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice.
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Xia JJ, Gateno J, Teichgraeber JF, Yuan P, Li J, Chen KC, Jajoo A, Nicol M, Alfi DM. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry. Int J Oral Maxillofac Surg 2016; 44:1441-50. [PMID: 26573563 DOI: 10.1016/j.ijom.2015.06.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.
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Affiliation(s)
- J J Xia
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA.
| | - J Gateno
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - J F Teichgraeber
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX, USA
| | - P Yuan
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - K-C Chen
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Department of Oral and Maxillofacial Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan
| | - A Jajoo
- Department of Mathematics, University of Houston, TX, USA
| | - M Nicol
- Department of Mathematics, University of Houston, TX, USA
| | - D M Alfi
- Oral and Maxillofacial Surgery, Institute for Academic Medicine, Houston Methodist Hospital, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, NY, USA; Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX, USA
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Comparison of time required for traditional versus virtual orthognathic surgery treatment planning. Int J Oral Maxillofac Surg 2016; 45:1065-9. [DOI: 10.1016/j.ijom.2016.03.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/09/2016] [Accepted: 03/15/2016] [Indexed: 11/20/2022]
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De Maesschalck T, Courvoisier DS, Scolozzi P. Computer-assisted versus traditional freehand technique in fibular free flap mandibular reconstruction: a morphological comparative study. Eur Arch Otorhinolaryngol 2016; 274:517-526. [DOI: 10.1007/s00405-016-4246-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
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Abstract
The authors assessed whether virtual surgery, performed with a soft tissue prediction program, could correctly simulate the actual surgical outcome, focusing on soft tissue movement. Preoperative and postoperative computed tomography (CT) data for 29 patients, who had undergone orthognathic surgery, were obtained and analyzed using the Simplant Pro software. The program made a predicted soft tissue image (A) based on presurgical CT data. After the operation, we obtained actual postoperative CT data and an actual soft tissue image (B) was generated. Finally, the 2 images (A and B) were superimposed and analyzed differences between the A and B. Results were grouped in 2 classes: absolute values and vector values. In the absolute values, the left mouth corner was the most significant error point (2.36 mm). The right mouth corner (2.28 mm), labrale inferius (2.08 mm), and the pogonion (2.03 mm) also had significant errors. In vector values, prediction of the right-left side had a left-sided tendency, the superior-inferior had a superior tendency, and the anterior-posterior showed an anterior tendency. As a result, with this program, the position of points tended to be located more left, anterior, and superior than the "real" situation. There is a need to improve the prediction accuracy for soft tissue images. Such software is particularly valuable in predicting craniofacial soft tissues landmarks, such as the pronasale. With this software, landmark positions were most inaccurate in terms of anterior-posterior predictions.
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232
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Fang JJ, Tu YH, Wong TY, Liu JK, Zhang YX, Leong IF, Chen KC. Evaluation of mandibular contour in patients with significant facial asymmetry. Int J Oral Maxillofac Surg 2016; 45:922-31. [DOI: 10.1016/j.ijom.2016.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 12/22/2015] [Accepted: 02/15/2016] [Indexed: 11/29/2022]
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233
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A new classification of mandibular asymmetry and evaluation of surgical-orthodontic treatment outcomes in Class III malocclusion. J Craniomaxillofac Surg 2016; 44:676-83. [DOI: 10.1016/j.jcms.2016.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/16/2016] [Accepted: 03/18/2016] [Indexed: 11/22/2022] Open
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234
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Adolphs N, Ernst N, Keeve E, Hoffmeister B. Contemporary Correction of Dentofacial Anomalies: A Clinical Assessment. Dent J (Basel) 2016; 4:dj4020011. [PMID: 29563453 PMCID: PMC5851261 DOI: 10.3390/dj4020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 11/16/2022] Open
Abstract
Contemporary computer-assisted technologies can support the surgical team in the treatment of patients affected by dentofacial deformities. Based on own experiences of 350 patients that received orthognathic surgery by the same team from 2007 to 2015, this clinical review is intended to give an overview of the results and risks related to the surgical correction of dentofacial anomalies. Different clinical and technological innovations that can contribute to improve the planning and transfer of corrective dentofacial surgery are discussed as well. However, despite the presence of modern technologies, a patient-specific approach and solid craftsmanship remain the key factors in this elective surgery.
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Affiliation(s)
- Nicolai Adolphs
- Department of Craniomaxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Mittelallee 2, Berlin 13353, Germany.
| | - Nicole Ernst
- Department of Craniomaxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Mittelallee 2, Berlin 13353, Germany.
| | - Erwin Keeve
- Department of Craniomaxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Mittelallee 2, Berlin 13353, Germany.
| | - Bodo Hoffmeister
- Department of Craniomaxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Mittelallee 2, Berlin 13353, Germany.
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235
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Janakiraman N, Feinberg M, Vishwanath M, Nalaka Jayaratne YS, Steinbacher DM, Nanda R, Uribe F. Integration of 3-dimensional surgical and orthodontic technologies with orthognathic "surgery-first" approach in the management of unilateral condylar hyperplasia. Am J Orthod Dentofacial Orthop 2016; 148:1054-66. [PMID: 26672712 DOI: 10.1016/j.ajodo.2015.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 11/16/2022]
Abstract
Recent innovations in technology and techniques in both surgical and orthodontic fields can be integrated, especially when treating subjects with facial asymmetry. In this article, we present a treatment method consisting of 3-dimensional computer-aided surgical and orthodontic planning, which was implemented with the orthognathic surgery-first approach. Virtual surgical planning, fabrication of surgical splints using the computer-aided design/computer-aided manufacturing technique, and prediction of final orthodontic occlusion using virtual planning with robotically assisted customized archwires were integrated for this patient. Excellent esthetic and occlusal outcomes were obtained in a short period of 5.5 months.
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Affiliation(s)
- Nandakumar Janakiraman
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn.
| | - Mark Feinberg
- Clinical instructor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn; private practice, Shelton, Conn
| | - Meenakshi Vishwanath
- Postgraduate resident, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Yasas Shri Nalaka Jayaratne
- Postgraduate resident, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Derek M Steinbacher
- Associate professor of surgery (plastic); assistant professor of pediatrics; director of Dental Services, Oral Maxillofacial and Craniofacial surgery, School of Medicine, Yale University, New Haven, Conn
| | - Ravindra Nanda
- Professor and head, Department of Craniofacial Sciences, Alumni Endowed Chair, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Flavio Uribe
- Associate professor and program director, Division of Orthodontics, Department of Craniofacial Sciences, Charles Burstone Professor, School of Dental Medicine, University of Connecticut, Farmington, Conn
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Lonic D, Pai BCJ, Yamaguchi K, Chortrakarnkij P, Lin HH, Lo LJ. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation. PLoS One 2016; 11:e0152014. [PMID: 27002726 PMCID: PMC4803320 DOI: 10.1371/journal.pone.0152014] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. PATIENTS AND METHODS This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. RESULTS 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. CONCLUSION Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D planning.
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Affiliation(s)
- Daniel Lonic
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty Chien-Jung Pai
- Department of Craniofacial Orthodontics, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kazuaki Yamaguchi
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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237
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Borba AM, Haupt D, de Almeida Romualdo LT, da Silva ALF, da Graça Naclério-Homem M, Miloro M. How Many Oral and Maxillofacial Surgeons Does It Take to Perform Virtual Orthognathic Surgical Planning? J Oral Maxillofac Surg 2016; 74:1807-26. [PMID: 27080045 DOI: 10.1016/j.joms.2016.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/08/2016] [Accepted: 03/13/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Virtual surgical planning (VSP) has become routine practice in orthognathic treatment planning; however, most surgeons do not perform the planning without technical assistance, nor do they routinely evaluate the accuracy of the postoperative outcomes. The purpose of the present study was to propose a reproducible method that would allow surgeons to have an improved understanding of VSP orthognathic planning and to compare the planned surgical movements with the results obtained. MATERIALS AND METHODS A retrospective cohort of bimaxillary orthognathic surgery cases was used to evaluate the variability between the predicted and obtained movements using craniofacial landmarks and McNamara 3-dimensional cephalometric analysis from computed tomography scans. The demographic data (age, gender, and skeletal deformity type) were gathered from the medical records. The data analysis included the level of variability from the predicted to obtained surgical movements as assessed by the mean and standard deviation. For the overall sample, statistical analysis was performed using the 1-sample t test. The statistical analysis between the Class II and III patient groups used an unpaired t test. RESULTS The study sample consisted of 50 patients who had undergone bimaxillary orthognathic surgery. The overall evaluation of the mean values revealed a discrepancy between the predicted and obtained values of less than 2.0 ± 2.0 mm for all maxillary landmarks, although some mandibular landmarks were greater than this value. An evaluation of the influence of gender and deformity type on the accuracy of surgical movements did not demonstrate statistical significance for most landmarks (P > .05). CONCLUSIONS The method provides a reproducible tool for surgeons who use orthognathic VSP to perform routine evaluation of the postoperative outcomes, permitting the identification of specific variables that could assist in improving the accuracy of surgical planning and execution.
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Affiliation(s)
- Alexandre Meireles Borba
- Researcher, Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá, Cuiabá, Brazil; Postdoctorate Researcher, Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil; and Visiting Researcher, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL
| | - Dustin Haupt
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL
| | - Leiliane Teresinha de Almeida Romualdo
- Dental Undergraduate Student, Faculty of Dentistry of the Federal University of Minas Gerais, Belo Horizonte, Brazil; Summer Course Student, Science Without Borders Program, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL
| | - André Luis Fernandes da Silva
- Former Master of Science Student, Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá, Cuiabá, Brazil
| | - Maria da Graça Naclério-Homem
- Associate Professor, Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Michael Miloro
- Professor, Department Head, and Program Director, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL.
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Zhang N, Liu S, Hu Z, Hu J, Zhu S, Li Y. Accuracy of virtual surgical planning in two-jaw orthognathic surgery: comparison of planned and actual results. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:143-51. [PMID: 27209483 DOI: 10.1016/j.oooo.2016.03.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/26/2016] [Accepted: 03/04/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aims to evaluate the accuracy of virtual surgical planning in two-jaw orthognathic surgery via quantitative comparison of preoperative planned and postoperative actual skull models. STUDY DESIGN Thirty consecutive patients who required two-jaw orthognathic surgery were included. A composite skull model was reconstructed by using Digital Imaging and Communications in Medicine (DICOM) data from spiral computed tomography (CT) and STL (stereolithography) data from surface scanning of the dental arch. LeFort I osteotomy of the maxilla and bilateral sagittal split ramus osteotomy (of the mandible were simulated by using Dolphin Imaging 11.7 Premium (Dolphin Imaging and Management Solutions, Chatsworth, CA). Genioplasty was performed, if indicated. The virtual plan was then transferred to the operation room by using three-dimensional (3-D)-printed surgical templates. Linear and angular differences between virtually simulated and postoperative skull models were evaluated. RESULTS The virtual surgical planning was successfully transferred to actual surgery with the help of 3-D-printed surgical templates. All patients were satisfied with the postoperative facial profile and occlusion. The overall mean linear difference was 0.81 mm (0.71 mm for the maxilla and 0.91 mm for the mandible); and the overall mean angular difference was 0.95 degrees. CONCLUSIONS Virtual surgical planning and 3-D-printed surgical templates facilitated the diagnosis, treatment planning, and accurate repositioning of bony segments in two-jaw orthognathic surgery.
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Affiliation(s)
- Nan Zhang
- Faculty, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shuguang Liu
- Faculty, Department of Oral and Maxillofacial Surgery, Guangdong Provincial Stomatological Hospital & affiliated Stomatological Hospital of Southern Medical University, Guangzhou, China
| | - Zhiai Hu
- Faculty, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Hu
- Faculty, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songsong Zhu
- Faculty, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Yunfeng Li
- Faculty, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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239
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Inverted L osteotomy: a new approach via intraoral access through the advances of virtual surgical planning and custom fixation. ORAL AND MAXILLOFACIAL SURGERY CASES 2016. [DOI: 10.1016/j.omsc.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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240
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Baan F, Liebregts J, Xi T, Schreurs R, de Koning M, Bergé S, Maal T. A New 3D Tool for Assessing the Accuracy of Bimaxillary Surgery: The OrthoGnathicAnalyser. PLoS One 2016; 11:e0149625. [PMID: 26901524 PMCID: PMC4762705 DOI: 10.1371/journal.pone.0149625] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/03/2016] [Indexed: 11/18/2022] Open
Abstract
AIM The purpose of this study was to present and validate an innovative semi-automatic approach to quantify the accuracy of the surgical outcome in relation to 3D virtual orthognathic planning among patients who underwent bimaxillary surgery. MATERIAL AND METHOD For the validation of this new semi-automatic approach, CBCT scans of ten patients who underwent bimaxillary surgery were acquired pre-operatively. Individualized 3D virtual operation plans were made for all patients prior to surgery. During surgery, the maxillary and mandibular segments were positioned as planned by using 3D milled interocclusal wafers. Consequently, post-operative CBCT scan were acquired. The 3D rendered pre- and postoperative virtual head models were aligned by voxel-based registration upon the anterior cranial base. To calculate the discrepancies between the 3D planning and the actual surgical outcome, the 3D planned maxillary and mandibular segments were segmented and superimposed upon the postoperative maxillary and mandibular segments. The translation matrices obtained from this registration process were translated into translational and rotational discrepancies between the 3D planning and the surgical outcome, by using the newly developed tool, the OrthoGnathicAnalyser. To evaluate the reproducibility of this method, the process was performed by two independent observers multiple times. RESULTS Low intra-observer and inter-observer variations in measurement error (mean error < 0.25 mm) and high intraclass correlation coefficients (> 0.97) were found, supportive of the observer independent character of the OrthoGnathicAnalyser. The pitch of the maxilla and mandible showed the highest discrepancy between the 3D planning and the postoperative results, 2.72° and 2.75° respectively. CONCLUSION This novel method provides a reproducible tool for the evaluation of bimaxillary surgery, making it possible to compare larger patient groups in an objective and time-efficient manner in order to optimize the current workflow in orthognathic surgery.
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Affiliation(s)
- Frank Baan
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Stokbro K, Aagaard E, Torkov P, Bell R, 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. [DOI: 10.1016/j.ijom.2015.07.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/31/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
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Li B, Shen SG, Yu H, Li J, Xia JJ, Wang X. A new design of CAD/CAM surgical template system for two-piece narrowing genioplasty. Int J Oral Maxillofac Surg 2015; 45:560-6. [PMID: 26725914 DOI: 10.1016/j.ijom.2015.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/28/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to develop and validate a new chin template system for a two-piece narrowing genioplasty. Nine patients with wide chin deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation (CASS) planning method. Surgical splints and chin templates were designed in a computer and fabricated using a three-dimensional printing technique. The chin template system included a cutting guide and a repositioning guide for a two-piece narrowing genioplasty. These guides were also designed to avoid the mental foramen area and inferior alveolar nerve loops during the osteotomy, for nerve protection. After surgery, the outcome evaluation was completed by first superimposing the postoperative computed tomography model onto the planned model, and then measuring the differences between the planned and actual outcomes. All surgeries were completed successfully using the chin template system. No inferior alveolar nerve damage was seen in this study. With the use of the chin templates, the largest linear root mean square deviation (RMSD) between the planned and the postoperative chin segments was 0.7mm and the largest angular RMSD was 4.5°. The results showed that the chin template system provides a reliable method of transfer for two-piece osseous narrowing genioplasty planning.
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Affiliation(s)
- B Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - S G Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - H Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - J Li
- Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA
| | - J J Xia
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China; Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, Houston Methodist Research Institute, Houston, TX, USA; Oral and Maxillofacial Surgery, Weill Medical College, Cornell University, New York, NY, USA
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China.
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Scolozzi P. Computer-aided design and computer-aided modeling (CAD/CAM) generated surgical splints, cutting guides and custom-made implants: Which indications in orthognathic surgery? ACTA ACUST UNITED AC 2015; 116:343-9. [PMID: 26598243 DOI: 10.1016/j.revsto.2015.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 09/27/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of the present report was to describe our indications, results and complications of computer-aided design and computer-aided modeling CAD/CAM surgical splints, cutting guides and custom-made implants in orthognathic surgery. PATIENTS AND METHODS We analyzed the clinical and radiological data of ten consecutive patients with dentofacial deformities treated using a CAD/CAM technique. Four patients had surgical splints and cutting guides for correction of maxillomandibular asymmetries, three had surgical cutting guides and customized internal distractors for correction of severe maxillary deficiencies and three had custom-made implants for additional chin contouring and/or mandibular defects following bimaxillary osteotomies and sliding genioplasty. We recorded age, gender, dentofacial deformity, surgical procedure and intra- and postoperative complications. RESULTS All of the patients had stable cosmetic results with a high rate of patient satisfaction at the 1-year follow-up examination. No intra- and/or postoperative complications were encountered during any of the different steps of the procedure. DISCUSSION This study demonstrated that the application of CAD/CAM patient-specific surgical splints, cutting guides and custom-made implants in orthognathic surgery allows for a successful outcome in the ten patients presented in this series.
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Affiliation(s)
- P Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Hôpitaux Universitaires de Genève, 1211 Genève, Switzerland.
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Möhlhenrich SC, Heussen N, Kamal M, Fritz U, Hölzle F, Modabber A. Limitations of osseous genioplasty in relation to the displacement distance: a computer-based comparative study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:670-8. [DOI: 10.1016/j.oooo.2015.06.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/25/2015] [Indexed: 11/24/2022]
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Möhlhenrich SC, Heussen N, Kamal M, Peters F, Fritz U, Hölzle F, Modabber A. Influence of setback and advancement osseous genioplasty on facial outcome: A computer-simulated study. J Craniomaxillofac Surg 2015; 43:2017-25. [DOI: 10.1016/j.jcms.2015.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/27/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022] Open
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246
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Gamache C, English JD, Salas-Lopez AM, Rong J, Akyalcin S. Assessment of image quality in maxillofacial cone-beam computed tomography imaging. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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247
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Lim SH, Kim MK, Kang SH. Genioplasty using a simple CAD/CAM (computer-aided design and computer-aided manufacturing) surgical guide. Maxillofac Plast Reconstr Surg 2015; 37:44. [PMID: 26636050 PMCID: PMC4656692 DOI: 10.1186/s40902-015-0044-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study introduces the design and fabrication of a simple surgical guide with which to perform genioplasty. METHODS A three-dimensional reconstruction of the patient's cranio-maxilla region was built, with a dentofacial skeletal model, then derived from CT DICOM data. A surgical simulation was performed on the maxilla and mandible, using three-dimensional cephalometry. We then simulated a full genioplasty, in silico, using the three-dimensional (3D) model of the mandible, according to the final surgical treatment plan. The simulation allowed us to design a surgical guide for genioplasty, which was then computer-rendered and 3D-printed. The manufactured surgical device was ultimately used in an actual genioplasty to guide the osteotomy and to move the cut bone segment to the intended location. RESULTS We successfully performed the osteotomy, as planned during a genioplasty, using the computer-aided design and computer-aided manufacturing (CAD/CAM) surgical guide that we initially designed and tested using simulated surgery. CONCLUSIONS The surgical guide that we developed proved to be a simple and practical tool with which to assist the surgeon in accurately cutting and removing bone segments, during a genioplasty surgery, as preoperatively planned during 3D surgical simulations.
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Affiliation(s)
- Se-Ho Lim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsan-donggu, Goyang, Gyeonggi-do 410-719 Republic of Korea
| | - Moon-Key Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsan-donggu, Goyang, Gyeonggi-do 410-719 Republic of Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsan-donggu, Goyang, Gyeonggi-do 410-719 Republic of Korea
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248
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Clinical feasibility and efficacy of using virtual surgical planning in bimaxillary orthognathic surgery without intermediate splint. J Craniofac Surg 2015; 26:501-5. [PMID: 25699539 DOI: 10.1097/scs.0000000000001530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Computer-aided jaw surgery has been extensively studied recently. The purpose of this study was to determine the clinical feasibility of performing bimaxillary orthognathic surgery without intermediate splint using virtual surgical planning and rapid prototyping technology. METHODS Twelve consecutive patients who underwent bimaxillary orthognathic surgery were included. The presented treatment plan here mainly consists of 6 procedures: (1) data acquisition from computed tomography (CT) of the skull and laser scanning of the dentition; (2) reconstruction and fusion of a virtual skull model with accurate dentition; (3) virtual surgery simulation including osteotomy and movement and repositioning of bony segments; (4) final surgical splint fabrication (no intermediate splint) using computer-aided design and rapid prototyping technology; (5) transfer of the virtual surgical plan to the operating room; and (6) comparison of the actual surgical outcome to the virtual surgical plan. RESULTS All procedures of the treatment were successfully performed on all 12 patients. In quantification of differences between simulated and actual postoperative outcome, we found that the mean linear difference was less than 1.8 mm, and the mean angular difference was less than 2.5 degrees in all evaluated patients. CONCLUSION Results from this study suggested that it was feasible to perform bimaxillary orthognathic surgery without intermediate splint. Virtual surgical planning and the guiding splints facilitated the diagnosis, treatment planning, accurate osteotomy, and bony segments repositioning in orthognathic surgery.
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Recording and Transferring Head Positions to the Virtual Head Using a Multicamera System and Laser Level. J Oral Maxillofac Surg 2015; 73:2039.e1-2039.e13. [DOI: 10.1016/j.joms.2015.06.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
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Uribe F, Adabi S, Janakiraman N, Allareddy V, Steinbacher D, Shafer D, Villegas C. Treatment duration and factors associated with the surgery-first approach: a two-center study. Prog Orthod 2015; 16:29. [PMID: 26359126 PMCID: PMC4565801 DOI: 10.1186/s40510-015-0101-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate treatment duration and number of appointments in orthognathic surgery using the surgery-first approach (SFA) and to evaluate the factors associated to these outcomes. Methods This was a retrospective chart review of consecutively treated patients with SFA at a University clinic and a private practice setting. Treatment duration, number of appointment, and factors associated to this duration such as patient demographics, type of surgery, use of 3D planning, and treatment center among others were evaluated. Multivariable linear regression models were used to examine the simultaneous association between all predictor variables and outcomes. Results Median treatment duration for patients undergoing SFA was 9.6 months [6.1 (25 % percentile); 13.4 (75 % percentile)] with a median number of 13.8 appointments [9 (25 % percentile); 17 (75 % percentile)]. Transverse maxillary expansion was associated with longer treatment duration and number of appointments. There was also a significant difference in number of appointments between the two treatment centers. Conclusions SFA significantly reduces treatment duration in orthognathic surgery. Transverse expansion is associated with longer treatment duration and number of appointments.
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Affiliation(s)
- Flavio Uribe
- Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Sara Adabi
- Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.,Division of Orthodontics, University of California at San Francisco, San Francisco, CA, 94143, USA
| | - Nandakumar Janakiraman
- Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | | | - Derek Steinbacher
- Department of Pediatrics, Dental Services, Oral Maxillofacial and Craniofacial Surgery, Yale School of Medicine, New Haven, CT, USA
| | - David Shafer
- Division of Oral and Maxillofacial Surgery, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Carlos Villegas
- Department of Orthodontics and Maxillofacial Surgery, CES University and Private Practice Medellin, Medellin, Colombia
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