How many oral and maxillofacial surgeons does it take to perform virtual orthognathic surgical planning?

• Published in: Journal of oral and maxillofacial surgery Vol. 74; no. 9; pp. 1807 - 1826
• Main Authors: Borba, Alexandre Meireles, DDS, PhD, Haupt, Dustin, DDS, Romualdo, Leiliane Teresinha de Almeida, DDS Stud, da Silva, André Luis Fernandes, DDS, MSc, da Graça Naclério-Homem, Maria, DDS, PhD, Miloro, Michael, DMD, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2016
• Subjects: Adolescent; Adult; Anatomic Landmarks; Cephalometry; Dentistry; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Orthognathic Surgical Procedures; Patient Care Planning; Surgeons - statistics & numerical data; Surgery; Surgery, Computer-Assisted; Tomography, X-Ray Computed; User-Computer Interface; Orthognathic Surgery; Tridimensional Cephalometry; Virtual Surgical Planning
• DOI: 10.1016/j.joms.2016.03.013
• EISSN: 1531-5053
• ISSN: 0278-2391

Abstract Purpose Virtual surgical planning (VSP) has become routine practice in orthognathic treatment planning, yet most surgeons do not perform the planning without technical assistance, nor do they routinely evaluate the accuracy of postsurgical outcomes. The purpose of this study is to propose a reproducible methodology that may allow surgeons to have an improved understanding of VSP orthognathic planning and to compare the planned surgical movements to the results obtained. Methods A retrospective cohort of bimaxillary orthognathic surgeries evaluated the variability between predicted and obtained movements using craniofacial landmarks and McNamara 3D cephalometric analysis from CT scans. Demographic data (age, gender, and type of skeletal deformity) was gathered from medical records, and data analysis included the level of variability from predicted to obtained surgical movements provided by mean and standard deviation values. For the overall sample, statistical analysis used one sample t-test, whereas statistical analysis between class II and class III patient groups used an unpaired t-test. Results The study sample consisted of 50 patients who underwent bimaxillary orthognathic surgery. The overall evaluation of mean values revealed a discrepancy between predicted and obtained values below 2.0mm (S.D. +/- 2.0mm) for all maxillary landmarks, although some mandibular landmarks were above this value. An evaluation of the influence of gender and type of deformity on the accuracy of surgical movements did not demonstrate statistical significance for most landmarks (p>.05). Conclusions The methodology provides a reproducible tool for surgeons that use virtual orthognathic surgery planning, to perform routine evaluation of post-surgical outcomes, permitting the identification of specific variables that may assist in the improvement in the accuracy of surgical planning and execution.