Department of Oral and Maxillofacial Surgery (Chair: Juergen Hoffmann MD, DDS, PhD), University Hospital Heidelberg, Germany.
Department of Medical Biometry and Informatics (Chair: Meinhard Kieser MSc, PhD), University Hospital Heidelberg, Germany.
J Craniomaxillofac Surg. 2017 Oct;45(10):1593-1599. doi: 10.1016/j.jcms.2017.08.005. Epub 2017 Aug 10.
Because of the inaccuracy of intermaxillary splints in orthognathic surgery, intraoperative guidance via a real time navigation system might represent a suitable method for enhancing the precision of maxillary positioning. Therefore, in this clinical trial, maxillary repositioning after Le Fort I osteotomy was guided splintless by an electromagnetic navigation system.
Conservatively planned maxillary reposition in each of 5 patients was transferred to a novel software module of the electromagnetic navigation system. Intraoperatively, after Le Fort I osteotomy, the software guided the maxilla to the targeted position. Accuracy was evaluated by pre- and postoperative cone beam computer tomography imaging (the vectorial distance of the incisal marker points was measured in three dimensions) and compared with that of a splint transposed control group.
The repositioning of the maxilla guided by the electromagnetic navigation system was intuitive and simple to accomplish. The achieved maxillary position with a deviation of 0.7 mm on average to the planned position was equally accurate compared with that of the splint transposed control group of 0.5 mm (p > 0.05).
The data of this clinical study display good accuracy for splintless electromagnetic-navigated maxillary positioning. Nevertheless, this method does not surpass the splint-encoded gold standard with regard to accuracy. Future investigations will be necessary to show the full potential of electromagnetic navigation in orthognathic surgery.
由于颌间夹板在正颌手术中的不准确性，通过实时导航系统进行术中引导可能代表了一种提高上颌定位精度的合适方法。因此，在这项临床试验中，通过电磁导航系统无夹板引导对 Le Fort I 截骨术后的上颌进行重新定位。
将 5 名患者的保守计划上颌重新定位转移到电磁导航系统的新软件模块中。在手术过程中，完成 Le Fort I 截骨术后，软件将上颌引导至目标位置。通过术前和术后锥形束计算机断层扫描成像（以三维方式测量切牙标记点的矢状距离）评估准确性，并与转位夹板对照进行比较。
电磁导航系统引导的上颌重新定位直观且简单。与转位夹板对照组的 0.5mm 相比，达到的上颌位置平均偏差为 0.7mm，与计划位置相同准确（p>0.05）。
这项临床研究的数据显示无夹板电磁导航上颌定位具有良好的准确性。然而，就准确性而言，这种方法并未超过带夹板的金标准。未来的研究将有必要展示电磁导航在正颌手术中的全部潜力。
