Evaluation of the Predictability and Accuracy of Orthognathic Surgery in the Era of Virtual Surgical Planning

Martínez, Marta María Pampín; Venturini, Alessandro Gutiérrez; Cevallos, Jorge Guiñales Díaz de; Blanco, María Barajas; Niño, Iñigo Aragón; Sánchez, Alvaro Moreiras; Vera, José Luis del Castillo Pardo de; Carretero, José Luis Cebrián

doi:10.3390/app12094305

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…The mandible-first sequence has been proposed as a solution to address issues with centric relation and, consequently, to enhance the predictability of achieving the intended position [29]. However, no significant beneficial effect could be demonstrated in this small sample size.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis

Ho,

Zhou,

van Riet

et al. 2023

JPM

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This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, p = 0.002 and 2.3 mm, p = 0.03, respectively) and counter-clockwise rotation (median 3.7°, p = 0.006 and 4.7°, p = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement (p = 0.048; adjusted R2 = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible (p = 0.012; adjusted R2 = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements (p > 0.45). Despite a significant reduction (p = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events/h to 19.4 events/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort (p = 0.389 and p = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.

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Section: Discussionmentioning

confidence: 99%

Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis

Ho,

Zhou,

van Riet

et al. 2023

JPM

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“…However, to the best of our knowledge, no studies have investigated the influence of posterior maxillary impaction, the magnitude of the jaw movements, and the type of rotational movements on a possible learning curve. These factors are surgical factors that affect surgical accuracy [ 12 , 17 , 18 ]. Therefore, the present study aimed to assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned jaw movements on a possible learning curve with a 3D semi-automated approach.…”

Section: Introductionmentioning

confidence: 99%

A learning curve in 3D virtual surgical planned orthognathic surgery

et al. 2023

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Objectives To assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned movements on a possible learning curve. Materials and methods This prospective cohort study included subjects who underwent bimaxillary surgery between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery of the Radboud University Medical Center, Nijmegen. 3D virtual surgical planning (VSP) was performed with CBCT data and digitalized dentition data. By using voxel-based matching with pre- and postoperative CBCT data the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned and achieved maxillary movement. Results Based on 124 subjects, the surgical accuracy increased annually from 2016 to 2020 in terms of vertical translations (0.82 ± 0.28 mm; p = 0.038) and yaw rotations (0.68 ± 0.22°; p = 0.028). An increase in surgical accuracy was observed when combining all six degrees of freedom (p = 0.021) and specifically between 2016 and 2020 (p = 0.004). An unfavorable learning curve was seen with posterior impaction and with a greater magnitude of movements. Conclusion The present study demonstrated a significant increase in surgical accuracy annually and therefore supports the presence of a learning curve. Clinical relevance Cases with planned maxillary posterior impaction and/or a great magnitude of jaw movements should be transferred from the 3D VSP with extra care to obtain a satisfactory surgical accuracy.

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The Evolution of Virtual Surgical Planning in Craniomaxillofacial Surgery: A Comprehensive Review

Joachim,

Miloro

2024

Journal of Oral and Maxillofacial Surgery

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Evaluation of the Predictability and Accuracy of Orthognathic Surgery in the Era of Virtual Surgical Planning

Cited by 3 publications

References 28 publications

Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis

Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis

A learning curve in 3D virtual surgical planned orthognathic surgery

The Evolution of Virtual Surgical Planning in Craniomaxillofacial Surgery: A Comprehensive Review

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