A Critical Evaluation of the Role of Virtual Surgical Planning in Adult Orthognathic Surgery
Karina Charipova, MD1, Victory C. Eze, BS2, Nia E. R. James, BA2, Salma A. Abdou, MD1, Christopher M. Fleury, MD1, Stephen B. Baker, MD, DDS1
1Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC; 2Howard University College of Medicine, Washington, DC
Background: Virtual surgical planning (VSP) has revolutionized orthognathic surgery by enhancing efficiency and accuracy of the treatment of skeletal deformities. This study evaluated a single surgeon’s use of this technology over the past 6 years.
Methods: A total of 68 surgical plans from 3D Systems (Littleton, CO) were reviewed for patients undergoing orthognathic surgery by the senior author between June 2015 and February 2021. VSP-specific data were collected including incidence of midline/cant correction, occlusal equilibration, serial splints, segmental osteotomies, and custom plates. Midline correction was defined as lateral change (≥1mm) in position of the maxillary incisor midline; cant correction was defined as vertical change (≥1mm) in position of the maxillary canines, maxillary molars, and mandibular molars.
Results: A total of 68 unique procedures in 62 patients (35 female, 27 male) were included with mean age 19.6±11.9 years. The most common procedure was a combined LeFort I and bilateral sagittal split osteotomy (BSSO) (52.9%). Nine patients underwent LeFort I osteotomy alone (8 single-piece, 1 multi-piece), 4 underwent BSSO alone, and 1 underwent BSSO and genioplasty. The remaining 54 LeFort I osteotomies (44 single-piece, 10 multi-piece) were combined with at least one other procedure (i.e., unilateral or bilateral SSO, genioplasty, condylectomy, mandibular body osteotomy, inverted L osteotomy). A total of 19 genioplasties were performed. Most patients (87.1%) underwent bimaxillary surgery (42 maxilla-first, 12 mandible-first). Thirty-two patients had maxillary midline correction. A total of 24 patients underwent maxillary cant correction; all patients who required occlusal plane adjustment at the maxillary canines also required adjustment at the maxillary molars. Twenty-three patients underwent mandibular cant correction with 14 requiring both maxillary and mandibular correction. Occlusal equilibration was performed in 21 patients. Custom plates were implemented in 16 patients, all during the latter 3 years of the study period. The incidence of bimaxillary surgery did not change between the first and second half of the study period (74.1% vs. 80.5%, p=0.533), but the incidence of genioplasty increased significantly (7.4% vs. 41.5%, p=0.002). Incidence of midline correction, cant correction, and occlusal equilibration did not change over time. Zero patients required serial splints; in no case was the VSP splint unusable.
Conclusions: These findings demonstrate the superior accuracy of VSP in detecting occlusal cants, asymmetry, and occlusal interferences compared to traditional methods. VSP also affords the surgeon auxiliary advantages such as versatility in splint design, surgical sequence, and fabrication of multiple splints when soft tissue elasticity is unpredictable.
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