Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion

  • Andong CAI ,
  • Xiaoxia WANG ,
  • Wenjuan ZHOU ,
  • Zhonghao LIU
Expand
  • 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Characteristic Laboratories of Colleges and Universities in Shandong Province for Digital Stomatology, School of Stomatology, Binzhou Medical University, Yantai 264003, Shandong, China
    3. Yantai Engineering Research Center for Digital Technology of Stomatology, The affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264000, Shandong, China

Received date: 2023-09-18

  Online published: 2024-02-06

Supported by

the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT23AO2)

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 (T0) and 1-week postoperative CT (T1) 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.

Cite this article

Andong CAI , Xiaoxia WANG , Wenjuan ZHOU , Zhonghao LIU . Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion[J]. Journal of Peking University(Health Sciences), 2024 , 56(1) : 74 -80 . DOI: 10.19723/j.issn.1671-167X.2024.01.012

References

1 何东明, 毛丽霞, 刘凯, 等. 精准牙-骨移动的手术先行正颌正畸联合治疗——数字医学时代的理念与尝试[J]. 口腔医学, 2022, 42 (1): 20- 28.
2 Ying X , Tian K , Zhang K , et al. Accuracy of virtual surgical planning in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach[J]. BMC Oral Health, 2021, 21 (1): 529.
3 Lee SJ , Yoo JY , Woo SY , et al. A complete digital workflow for planning, simulation, and evaluation in orthognathic surgery[J]. J Clin Med, 2021, 10 (17): 4000.
4 Stamm T , Kanemeier M , Dirksen D , et al. The position of the virtual hinge axis in relation to the maxilla in digital orthognathic surgery planning: A k-means cluster analysis[J]. J Clin Med, 2023, 12 (10): 3582.
5 Dvoranova B , Vavro M , Czako L , et al. Does orthognathic surgery affect mandibular condyle position? A retrospective study[J]. Oral Maxillofac Surg, 2023,
6 Alkaabl S , Maningky M , Helder MN , et al. Virtual and tradi-tional surgical planning in orthognathic surgery: Systematic review and meta-analysis[J]. Br J Oral Maxillofac Surg, 2022, 60 (9): 1184- 1191.
7 Quast A , Santander P , Kahlmeier T , et al. Predictability of maxillary positioning: A 3D comparison of virtual and conventional orthognathic surgery planning[J]. Head Face Med, 2021, 17 (1): 27.
8 周颖欣, 何泽, 刘瑶, 等. 正颌术中髁突定位技术的研究进展[J]. 口腔疾病防治, 2022, 30 (4): 283- 288.
9 Lee K , Tan S , Tan D , et al. Accuracy of a digital workflow for bimaxillary orthognathic surgery: Comparison of planned and actual outcomes[J]. Int J Comput Dent, 2022, 25 (4): 397- 405.
10 Almadi D , Benington P , Ju X , et al. Reproducibility and reliabi-lity of digital occlusal planning for orthognathic surgery[J]. Int J Oral Maxillofac Surg, 2023, 52 (10): 1074- 1080.
11 Apostolakis D , Michelinakis G , Kamposlora P , et al. The current state of computer assisted orthognathic surgery: A narrative review[J]. J Dent, 2022, 119, 104052.
12 Han JJ , Woo SY , Yi WJ , et al. Robot-assisted maxillary positioning in orthognathic surgery: A feasibility and accuracy evaluation[J]. J Clin Med, 2021, 10 (12): 2596.
13 Neeraj , Reddy SG , Dixit A , et al. Relapse and temporomandibular joint dysfunction (TMD) as postoperative complication in skeletal class Ⅲ patients undergoing bimaxillary orthognathic surgery: A systematic review[J]. J Oral Biol Craniofac Res, 2021, 11 (4): 467- 475.
14 Kaur A , Rattan V , Rai S , et al. Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD): A prospective study[J]. J Craniomaxillofac Surg, 2022, 50 (12): 915- 922.
15 Ma RH , LI G , Yin S , et al. Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography[J]. Clin Oral Investig, 2019, 24 (8): 2663- 2672.
16 郑博文, 刘奕. 颞下颌关节紊乱病与错畸形特征的关系[J]. 中国实用口腔科杂志, 2023, 16 (2): 139- 142.
17 Ma W , Niu S , Wang L , et al. Clinical Application of individua-lized 3D-printed templates in the treatment of condylar osteochondroma[J]. Healthcare, 2022, 10 (11): 2163.
18 Shrestha A , Song SH , Aung HN , et al. Three-dimensional cephalometric analysis: The changes in condylar position pre- and post-orthognathic surgery with skeletal class Ⅲ malocclusion[J]. J Craniofac Surg, 2021, 32 (2): 546- 551.
19 史舒菡, 马国武. 早期去除内固定解决正颌术后中度髁突移位1例[J]. 口腔医学研究, 2022, 38 (2): 197- 198.
20 Berk?z ? , Karaali S , Kozano?lu E , et al. The relationship between fixation method and early central condylar sagging after bilateral sagittal split ramus osteotomy in orthognathic surgery[J]. J Craniomaxillofac Surg, 2020, 48 (10): 928- 932.
21 Zachariah T , Bharathi R , Ramanatan M , et al. The anatomical basis for plate fixation in BSSO to minimize condylar torquing: A comparative CT study of mandibular advancement and setback[J]. J Maxillofac Oral Surg, 2021, 20 (3): 432- 438.
22 Chow W , He Z , Liu Y , et al. Intraoperative condylar positioning techniques on mandible in orthognathic surgery[J]. Orthod Craniofac Res, 2022, 25 (4): 449- 458.
23 Barretto MDA , Melhem-Elias F , Deboni MCZ . Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: A systematic review[J]. J Stomatol Oral Maxillofac Surg, 2022, 123 (3): 345- 352.
24 Quast A , Santander P , Trautmann J , et al. 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?[J]. Int J Oral Maxillofac Surg, 2020, 49 (10): 1303- 1310.
Outlines

/