[Comparison of the Virtual Surgical Planning Position of Maxilla and Condyle with the Postoperative Real Position in Patients with Mandibular Protrusion]

Overview

Journal Beijing Da Xue Xue Bao Yi Xue Ban

Specialty General Medicine

Date 2024 Feb 6

PMID 38318899

Authors

Andong Cai

Xiaoxia Wang

Wenjuan Zhou

Zhonghao Liu

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the difference between virtual surgical planning (VSP) position and postoperative real position of maxilla and condyle, and to explore the degree of intraoperative realization of VSP after orthognathic surgery.

Methods: In this study, 36 patients with mandibular protrusion deformity from January 2022 to December 2022 were included. All the patients had been done bilateral sagittal split ramus osteotomy (SSRO) combined with Le Fort Ⅰ osteotomy under guidance of VSP. The VSP data (T) and 1-week postoperative CT (T) were collected, the 3D model of postoperative CT was established and segmented into upper and lower jaws in CCMF Plan software. At the same time, accor-ding to the morphology of palatal folds, the virtual design was registered with the postoperative model, and the unclear maxillary dentition in the postoperative model was replaced. Then the postoperative model was matched with VSP model by registration of upper skull anatomy that was not affected by the operation. The three-dimensional reference plane and coordinate system were established. Selecting anatomical landmarks and their connections of condyle and maxilla for the measurement, we compared the coordinate changes of marker points in three directions, and the angle changes between the line connecting the marker points and the reference plane to analyze the positional deviation and the angle deviation of the postoperative condyle and maxilla compared to VSP.

Results: The postoperative real position of the maxilla deviates from the VSP by nearly 1 mm in the horizontal and vertical directions, and the anteroposterior deviation was about 1.5 mm. In addition, most patients had a certain degree of counterclockwise rotation of the maxilla after surgery. Most of the bilateral condyle moved forward, outward and downward (the average distance deviation was 0.15 mm, 1.54 mm, 2.19 mm, respectively), and rotated forward, outward and upward (the average degree deviation was 4.32°, 1.02°, 0.86°, respectively) compared with the VSP.

Conclusion: VSP can be mostly achieved by assistance of 3D printed occlusal plates, but there are certain deviations in the postoperative real position of maxilla and condyle compared with VSP, which may be related to the rotation axis of the mandible in the VSP. It is necessary to use patient personalized condylar rotation axis for VSP, and apply condylar positioning device to further improve surgical accuracy.

References

Shrestha A, Song S, Aung H, Sangwatanakul J, Zhou N . Three-Dimensional Cephalometric Analysis: The Changes in Condylar Position Pre- and Post-Orthognathic Surgery With Skeletal Class III Malocclusion. J Craniofac Surg. 2020; 32(2):546-551. PMC: 7908865. DOI: 10.1097/SCS.0000000000006873. View

Chow W, He Z, Liu Y, Song J, Xu C, Luo E . Intraoperative condylar positioning techniques on mandible in orthognathic surgery. Orthod Craniofac Res. 2022; 25(4):449-458. DOI: 10.1111/ocr.12568. View

Quast A, Santander P, Kahlmeier T, Moser N, Schliephake H, Meyer-Marcotty P . Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning. Head Face Med. 2021; 17(1):27. PMC: 8276391. DOI: 10.1186/s13005-021-00279-x. View

Alkaabi S, Maningky M, Helder M, Alsabri G . Virtual and traditional surgical planning in orthognathic surgery - systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2022; 60(9):1184-1191. DOI: 10.1016/j.bjoms.2022.07.007. View

Neeraj , Reddy S, Dixit A, Agarwal P, Chowdhry R, Chug A . Relapse and temporomandibular joint dysfunction (TMD) as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery: A systematic review. J Oral Biol Craniofac Res. 2021; 11(4):467-475. PMC: 8319520. DOI: 10.1016/j.jobcr.2021.06.003. View

Dvoranova B, Vavro M, Czako L, Hirjak D . Does orthognathic surgery affect mandibular condyle position? A retrospective study. Oral Maxillofac Surg. 2023; 28(2):639-643. PMC: 11144676. DOI: 10.1007/s10006-023-01181-3. View

Almadi D, Benington P, Ju X, Ayoub A . Reproducibility and reliability of digital occlusal planning for orthognathic surgery. Int J Oral Maxillofac Surg. 2023; 52(10):1074-1080. DOI: 10.1016/j.ijom.2023.03.001. View

Ying X, Tian K, Zhang K, Ma X, Guo H . Accuracy of virtual surgical planning in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach. BMC Oral Health. 2021; 21(1):529. PMC: 8518167. DOI: 10.1186/s12903-021-01892-7. View

Lee S, Yoo J, Woo S, Yang H, Kim J, Huh K . A Complete Digital Workflow for Planning, Simulation, and Evaluation in Orthognathic Surgery. J Clin Med. 2021; 10(17). PMC: 8432567. DOI: 10.3390/jcm10174000. View

10.

Berkoz O, Karaali S, Kozanoglu E, Akalin B, Ceri A, Baris S . The relationship between fixation method and early central condylar sagging after bilateral sagittal split ramus osteotomy in orthognathic surgery. J Craniomaxillofac Surg. 2020; 48(10):928-932. DOI: 10.1016/j.jcms.2020.07.017. View

11.

Zachariah T, Bharathi R, Ramanathan M, Parameswaran A . The Anatomical Basis for Plate Fixation in BSSO to Minimize Condylar Torquing: A Comparative CT Study of Mandibular Advancement and Setback. J Maxillofac Oral Surg. 2021; 20(3):432-438. PMC: 8313615. DOI: 10.1007/s12663-021-01564-7. View

12.

Apostolakis D, Michelinakis G, Kamposiora P, Papavasiliou G . The current state of computer assisted orthognathic surgery: A narrative review. J Dent. 2022; 119:104052. DOI: 10.1016/j.jdent.2022.104052. View

13.

Stamm T, Kanemeier M, Dirksen D, Middelberg C, Hohoff A, Kleinheinz J . The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis. J Clin Med. 2023; 12(10). PMC: 10219012. DOI: 10.3390/jcm12103582. View

14.

Ma R, Li G, Yin S, Sun Y, Li Z, Ma X . Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography. Clin Oral Investig. 2019; 24(8):2663-2672. DOI: 10.1007/s00784-019-03128-z. View

15.

Lee K, Tan S, Tan D, Yong C, Chew M . Accuracy of a digital workflow for bimaxillary orthognathic surgery: comparison of planned and actual outcomes. Int J Comput Dent. 2022; 25(4):397-405. DOI: 10.3290/j.ijcd.b2599749. View

16.

Ma W, Niu S, Wang L, Peng C, Fu S, Zhang C . Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma. Healthcare (Basel). 2022; 10(11). PMC: 9690499. DOI: 10.3390/healthcare10112163. View

17.

Quast A, Santander P, Trautmann J, Moser N, Schliephake H, Meyer-Marcotty P . A new approach in three dimensions to define pre- and intraoperative condyle-fossa relationships in orthognathic surgery - is there an effect of general anaesthesia on condylar position?. Int J Oral Maxillofac Surg. 2020; 49(10):1303-1310. DOI: 10.1016/j.ijom.2020.02.011. View

18.

Kaur A, Rattan V, Rai S, Singh S, Kalra P, Sharma S . Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD)- a prospective study. J Craniomaxillofac Surg. 2023; 50(12):915-922. DOI: 10.1016/j.jcms.2022.12.003. View

19.

Han J, Woo S, Yi W, Hwang S . Robot-Assisted Maxillary Positioning in Orthognathic Surgery: A Feasibility and Accuracy Evaluation. J Clin Med. 2021; 10(12). PMC: 8231103. DOI: 10.3390/jcm10122596. View

20.

Mda B, F M, McZ D . Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: a systematic review. J Stomatol Oral Maxillofac Surg. 2021; 123(3):345-352. DOI: 10.1016/j.jormas.2021.06.004. View