Contemporary management of complex craniofacial trauma: virtual planning, navigation and the novel thermoformed cage splints in a strategic, sequential, computer-guided protocol

The accuracy of virtual surgical planning assisted management for L-shaped reduction malarplasty: A retrospective study

This study aims to evaluate the accuracy of L-shaped reduction malarplasty with bone setback or resection on the zygoma and the mortice and tenon joint structure on the zygomatic arch under the guidance of virtual surgical planning (VSP). Adult patients with zygomatic protrusion or hypertrophy were enrolled and divided. L-shaped reduction malarplasty with or without bone resection and with the mortice and tenon joint structure on the zygomatic arch was conducted either by digital procedures comprising VSP and three-dimensional (3D) printing titanium templates (Group I) or by conventional methods (Group II). Positions of representative landmarks and superimposition models were analyzed by 3D cephalometry. Satisfaction rate and incidences of clinical complications were compared as well. Satisfactory reduction of zygomatic protrusion or hypertrophy was recognized among all 78 patients. Improved symmetry and great surgical accuracy were observed according to the cephalometry analyses. The bone segment movement of virtual plans and actual results in Group I were measured and showed no obvious difference for the inward movement (5.42 ± 0.98 mm vs. 5.33± 0.93 mm, P = 0.6906) and the sagittal overlap (4.77 ± 1.32 mm vs. 4.87± 1.21 mm, P = 0.7386) at the zygoma roots, along with the step length at the long-arm of the L-shaped osteotomy line (2.43 ± 1.11 mm vs. 2.39± 0.89 mm, P = 0.8665). The high resemblance between virtual plans and actual results was depicted via superimposition models. Meanwhile, a higher satisfaction rate (28 in 36, 78% vs. 20 in 42, 48%) and a lower incidence rate of complications (11 in 36, 31% vs. 21 in 42, 50%) were found in Group I. Within the limitations of the study it seems that the application of VSP in reduction malarplasty could significantly contribute to better surgical accuracy and reduced difficulties in the operation, which would be beneficial to patients with zygoma hypertrophy or prominence.