Dekker Paige K, Fleury Christopher M, Abdou Salma A, Charipova Karina, Eze Victory C, James Nia E R, Baker Stephen B
Georgetown University School of Medicine.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.
J Craniofac Surg. 2022 Oct 1;33(7):2005-2010. doi: 10.1097/SCS.0000000000008677. Epub 2022 Jul 27.
The evolution of virtual surgical planning (VSP) in the last 2 decades has led to improved precision and efficiency for orthognathic surgery, both pre- and intraoperatively. This study evaluates a single surgeon's experience with this technology over the past 6 years. Patients undergoing orthognathic surgery using VSP with the senior author between 2015 and 2021 were retrospectively reviewed. Virtual surgical planning -specific data including incidence of midline/cant correction, occlusal equilibration, serial splints, segmental osteotomies, and custom plates were recorded and analyzed. Sixty patients undergoing orthognathic surgery using simulated VSP in the study period were retrospectively reviewed. Mean age at time of surgery was 23.5±7.9 years. Forty-nine patients (81.7%) underwent LeFort I osteotomy combined with at least 1 additional procedure (eg,unilateral or bilateral sagittal split osteotomy, condylectomy, genioplasty, etc.). Twenty-six (43.3%) of patients in the studied cohort underwent maxillary midline correction, 30.0% required occlusal equilibration, 36.7% underwent maxillary molar cant correction, 30.0% underwent mandibular cant correction, and 21.7% required both maxillary and mandibular cant correction. Three patients required serial splinting, and 15 patients (25.0%) required modification of splint design. Custom plates were utilized in 15 patients (25.0%). This study demonstrates the utility of VSP in accurately detecting occlusal cants, asymmetry, and occlusal interferences. Virtual surgical planning also allows for a dynamic preoperative planning process, offering the surgeon a high degree of versatility in splint design, and the ability to fabricate multiple customized splints for each case. This is particularly useful in patients with limited or unpredictable soft tissue elasticity.
在过去20年中，虚拟手术规划（VSP）的发展提高了正颌手术在术前和术中的精度与效率。本研究评估了一位外科医生在过去6年中使用该技术的经验。对2015年至2021年间与资深作者一起接受使用VSP的正颌手术的患者进行了回顾性研究。记录并分析了虚拟手术规划的特定数据，包括中线/偏斜矫正、咬合平衡、连续夹板、节段性截骨术和定制钢板的发生率。对研究期间60例接受模拟VSP正颌手术的患者进行了回顾性研究。手术时的平均年龄为23.5±7.9岁。49例患者（81.7%）接受了LeFort I截骨术并至少进行了1项其他手术（如单侧或双侧矢状劈开截骨术、髁突切除术、颏成形术等）。研究队列中的26例患者（43.3%）进行了上颌中线矫正，30.0%需要咬合平衡，36.7%进行了上颌磨牙偏斜矫正，30.0%进行了下颌偏斜矫正，21.7%需要上颌和下颌偏斜矫正。3例患者需要连续夹板固定，15例患者（25.0%）需要修改夹板设计。15例患者（25.0%）使用了定制钢板。本研究证明了VSP在准确检测咬合偏斜、不对称和咬合干扰方面的实用性。虚拟手术规划还允许进行动态术前规划过程，为外科医生在夹板设计方面提供了高度的通用性，并能够为每个病例制作多个定制夹板。这在软组织弹性有限或不可预测的患者中特别有用。
