From the Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine.
Plast Reconstr Surg. 2019 Jul;144(1):89e-97e. doi: 10.1097/PRS.0000000000005744.
Virtual surgical planning has facilitated preoperative planning, splint accuracy, and intraoperative efficiency in orthognathic surgery. The translation of the virtual surgical plan to the actual result has not been adequately examined. The authors examined the conformity of the virtual surgical plan to the postoperative result. They hypothesize that the greatest conformity exists in the anteroposterior dimensions.
The authors examined patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty. The preoperative virtual surgical planning file and postoperative cone beam computed tomographic scan were registered in Mimics using unchanged landmarks. The conformity to the virtual surgical plan was quantified using linear and angular measurements between bone surface landmarks. Results were compared using t tests, with p < 0.05 considered statistically significant RESULTS:: One hundred patients who underwent Le Fort I maxillary advancement, bilateral sagittal split osteotomy, and genioplasty were included. Three-dimensional analysis showed significant differences between the plan and outcome for the following landmarks: A point (y, p = 0.04; z, p = 0.04), B point (y, p = 0.02; z, p = 0.02), pogonion (y, p = 0.04), menton (x, p = 0.02; y, p = 0.01; z, p = 0.03), and anterior nasal spine (x, p = 0.04; y, p = 0.04; z, p = 0.01). Angular measurements sella-nasion-A point, sella-nasion-B point, and A point-nasion-B point were not statistically different.
There is a high degree of conformity comparing the orthognathic virtual surgical plan to the actual postoperative result. However, some incongruency is seen vertically (maxilla) and sagittally (mandible, chin). Departures of the actual position compared with the plan could be the result of condylar position changes, osteotomy locations, aesthetic intraoperative decisions, and/or play in the system.
虚拟手术规划促进了正颌手术的术前规划、夹板准确性和术中效率。虚拟手术计划向实际结果的转化尚未得到充分检验。作者研究了虚拟手术计划与术后结果的一致性。他们假设前后方向的一致性最大。
作者检查了接受 Le Fort I 上颌骨推进术、双侧矢状劈开截骨术和颏成形术的患者。使用未改变的标志，在 Mimics 中对术前虚拟手术计划文件和术后锥形束计算机断层扫描进行配准。使用骨表面标志之间的线性和角度测量来量化与虚拟手术计划的一致性。使用 t 检验进行结果比较，p < 0.05 认为具有统计学意义。
共纳入 100 例行 Le Fort I 上颌骨推进术、双侧矢状劈开截骨术和颏成形术的患者。三维分析显示，以下标志的计划与结果之间存在显著差异：A 点（y，p = 0.04；z，p = 0.04）、B 点（y，p = 0.02；z，p = 0.02）、眶点（y，p = 0.04）、颏部（x，p = 0.02；y，p = 0.01；z，p = 0.03）和前鼻棘（x，p = 0.04；y，p = 0.04；z，p = 0.01）。蝶鞍-前鼻棘 A 点、蝶鞍-前鼻棘 B 点和 A 点-前鼻棘 B 点的角度测量无统计学差异。
将正颌术虚拟手术计划与实际术后结果进行比较，具有高度的一致性。然而，在垂直方向（上颌）和矢状方向（下颌、颏部）上存在一些不一致。实际位置与计划的偏差可能是由于髁突位置变化、截骨位置、术中美学决策和/或系统松动所致。
