The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Accurate transfer of bimaxillary orthognathic surgical plans using computer-aided intraoperative navigation

  • Chen, Chen (Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University) ;
  • Sun, Ningning (Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University) ;
  • Jiang, Chunmiao (Department of Orthodontics, The Affiliated Hospital of Qingdao University) ;
  • Liu, Yanshan (Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University) ;
  • Sun, Jian (Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University)
  • Received : 2020.10.27
  • Accepted : 2021.02.15
  • Published : 2021.09.25
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Abstract

Objective: To examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery by comparing preoperative planning and postoperative outcome. Methods: The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. Intraoperatively, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the Le Fort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Real-time Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcomes were calculated. Results: The mean linear difference was 0.79 mm (maxilla: 0.62 mm, mandible: 0.88 mm) and the overall mean angular difference was 1.20°. The observed difference in the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was < 1 mm in 40 cases. Conclusions: This study demonstrates the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method for the accurate transfer of the surgical plan during an operation.

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References

  1. Xia JJ, Gateno J, Teichgraeber JF, Christensen AM, Lasky RE, Lemoine JJ, et al. Accuracy of the computer-aided surgical simulation (CASS) system in the treatment of patients with complex craniomaxillofacial deformity: a pilot study. J Oral Maxillofac Surg 2007;65:248-54. https://doi.org/10.1016/j.joms.2006.10.005
  2. Xia JJ, Gateno J, Teichgraeber JF. New clinical protocol to evaluate craniomaxillofacial deformity and plan surgical correction. J Oral Maxillofac Surg 2009;67:2093-106. https://doi.org/10.1016/j.joms.2009.04.057
  3. Hsu SS, Gateno J, Bell RB, Hirsch DL, Markiewicz MR, Teichgraeber JF, et al. Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg 2013;71:128-42. https://doi.org/10.1016/j.joms.2012.03.027
  4. Gateno J, Xia JJ, Teichgraeber JF. New 3-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg 2011;69:606-22. https://doi.org/10.1016/j.joms.2010.09.010
  5. Sharifi A, Jones R, Ayoub A, Moos K, Walker F, Khambay B, et al. How accurate is model planning for orthognathic surgery? Int J Oral Maxillofac Surg 2008;37:1089-93. https://doi.org/10.1016/j.ijom.2008.06.011
  6. Xia J, Ip HH, Samman N, Wang D, Kot CS, Yeung RW, et al. Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy. Int J Oral Maxillofac Surg 2000;29:11-7. https://doi.org/10.1016/S0901-5027(00)80116-2
  7. Zinser MJ, Mischkowski RA, Sailer HF, Zoller JE. Computer-assisted orthognathic surgery: feasibility study using multiple CAD/CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113: 673-87. https://doi.org/10.1016/j.oooo.2011.11.009
  8. Tran NH, Tantidhnazet S, Raocharernporn S, Kiattavornchareon S, Pairuchvej V, Wongsirichat N. Accuracy of three-dimensional planning in surgery-first orthognathic surgery: planning versus outcome. J Clin Med Res 2018;10:429-36. https://doi.org/10.14740/jocmr3372w
  9. 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. https://doi.org/10.1016/j.oooo.2016.03.004
  10. Polley JW, Figueroa AA. Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery. J Oral Maxillofac Surg 2013;71:911-20. https://doi.org/10.1016/j.joms.2012.11.004
  11. Li B, Zhang L, Sun H, Yuan J, Shen SG, Wang X. A novel method of computer aided orthognathic surgery using individual CAD/CAM templates: a combination of osteotomy and repositioning guides. Br J Oral Maxillofac Surg 2013;51:e239-44. https://doi.org/10.1016/j.bjoms.2013.03.007
  12. Baumann A, Schicho K, Klug C, Wagner A, Ewers R. Computer-assisted navigational surgery in oral and maxillofacial surgery. Atlas Oral Maxillofac Surg Clin North Am 2005;13:41-9. https://doi.org/10.1016/j.cxom.2004.10.002
  13. Ewers R, Schicho K, Undt G, Wanschitz F, Truppe M, Seemann R, et al. Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review. Int J Oral Maxillofac Surg 2005;34:1-8. https://doi.org/10.1016/j.ijom.2004.03.018
  14. Stokbro K, Aagaard E, Torkov P, Bell RB, Thygesen T. Virtual planning in orthognathic surgery. Int J Oral Maxillofac Surg 2014;43:957-65. https://doi.org/10.1016/j.ijom.2014.03.011
  15. Lin HH, Lo LJ. Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: a literature review. J Formos Med Assoc 2015;114:300-7. https://doi.org/10.1016/j.jfma.2015.01.017
  16. Xia JJ, Gateno J, Teichgraeber JF. Three-dimensional computer-aided surgical simulation for maxillofacial surgery. Atlas Oral Maxillofac Surg Clin North Am 2005;13:25-39. https://doi.org/10.1016/j.cxom.2004.10.004
  17. Yu H, Shen SG, Wang X, Zhang L, Zhang S. The indication and application of computer-assisted navigation in oral and maxillofacial surgery-Shanghai's experience based on 104 cases. J Craniomaxillofac Surg 2013;41:770-4. https://doi.org/10.1016/j.jcms.2013.01.016
  18. Sadiq Z, Collyer J, Sneddon K, Walsh S. Orthognathic treatment of asymmetry: two cases of "waferless" stereotactic maxillary positioning. Br J Oral Maxillofac Surg 2012;50:e27-9.
  19. Tsuji M, Noguchi N, Shigematsu M, Yamashita Y, Ihara K, Shikimori M, et al. A new navigation system based on cephalograms and dental casts for oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2006;35:828-36. https://doi.org/10.1016/j.ijom.2006.02.024
  20. Mazzoni S, Badiali G, Lancellotti L, Babbi L, Bianchi A, Marchetti C. Simulation-guided navigation: a new approach to improve intraoperative threedimensional reproducibility during orthognathic surgery. J Craniofac Surg 2010;21:1698-705. https://doi.org/10.1097/SCS.0b013e3181f3c6a8
  21. Bell RB. Computer planning and intraoperative navigation in orthognathic surgery. J Oral Maxillofac Surg 2011;69:592-605. https://doi.org/10.1016/j.joms.2009.06.030
  22. Shim BK, Shin HS, Nam SM, Kim YB. Real-time navigation-assisted orthognathic surgery. J Craniofac Surg 2013;24:221-5. https://doi.org/10.1097/SCS.0b013e318267bb76
  23. Zinser MJ, Mischkowski RA, Dreiseidler T, Thamm OC, Rothamel D, Zoller JE. Computer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display. Br J Oral Maxillofac Surg 2013; 51:827-33. https://doi.org/10.1016/j.bjoms.2013.06.014
  24. Han B, Wang X, Li Z, Yi B, Liang C, Wang X. Hemimandibular hyperplasia correction by simultaneous orthognathic surgery and condylectomy under digital guidance. J Oral Maxillofac Surg 2018;76:1563. e1-1563.e18.
  25. Sun Y, Luebbers HT, Agbaje JO, Lambrichts I, Politis C. The accuracy of image-guided navigation for maxillary positioning in bimaxillary surgery. J Craniofac Surg 2014;25:1095-9. https://doi.org/10.1097/SCS.0000000000000633
  26. Luebbers HT, Messmer P, Obwegeser JA, Zwahlen RA, Kikinis R, Graetz KW, et al. Comparison of different registration methods for surgical navigation in cranio-maxillofacial surgery. J Craniomaxillofac Surg 2008;36:109-16. https://doi.org/10.1016/j.jcms.2007.09.002
  27. Ong TK, Banks RJ, Hildreth AJ. Surgical accuracy in Le Fort I maxillary osteotomies. Br J Oral Maxillofac Surg 2001;39:96-102. https://doi.org/10.1054/bjom.2000.0577
  28. Xia JJ, Shevchenko L, Gateno J, Teichgraeber JF, Taylor TD, Lasky RE, et al. Outcome study of computer-aided surgical simulation in the treatment of patients with craniomaxillofacial deformities. J Oral Maxillofac Surg 2011;69:2014-24. https://doi.org/10.1016/j.joms.2011.02.018
  29. Mischkowski RA, Zinser MJ, Kubler AC, Krug B, Seifert U, Zoller JE. Application of an augmented reality tool for maxillary positioning in orthognathic surgery - a feasibility study. J Craniomaxillofac Surg 2006;34:478-83. https://doi.org/10.1016/j.jcms.2006.07.862
  30. Severt TR, Proffit WR. The prevalence of facial asymmetry in the dentofacial deformities population at the University of North Carolina. Int J Adult Orthodon Orthognath Surg 1997;12:171-6.