Tachizawa Kotaro, Sugahara Keisuke, Koyachi Masahide, Odaka Kento, Matsunaga Satoru, Sugimoto Maki, Katakura Akira
Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, Japan.
Oral Health Science Center, Tokyo Dental College, Tokyo, Japan.
Quant Imaging Med Surg. 2025 May 1;15(5):4774-4790. doi: 10.21037/qims-24-2333. Epub 2025 Apr 10.
Genioplasty is performed as part of orthognathic surgery to correct jaw deformities. This procedure presents challenges in terms of osteosynthesis accuracy. This study aimed to evaluate the precision of preoperative planning in genioplasty using computer-aided design/computer-aided manufacturing (CAD/CAM) with three-dimensional (3D) printable biomaterials and mixed reality (MR) technology with a head-mounted display (Microsoft HoloLens 2) and a registration marker.
Twenty-six patients underwent genioplasty using either only CAD/CAM devices (control group, n=10) or CAD/CAM with additional MR technology (experimental group, n=16). CAD/CAM devices were created based on virtual surgical planning (VSP), and MR holograms created based on VSP data were projected onto the surgical area using Microsoft HoloLens 2. After surgery, the planned model was compared with the postoperative computed tomography (CT) image, measuring the 3D surface and the differences in position and rotation using the root mean square deviation (RMSD) and Bland-Altman's method. Both analyses are blinded.
The average 3D surface analysis errors within 2 mm ranged between 62.20-100.00% (control group) and 99.30-100.00% (experimental group), with mean errors of 92.12% and 99.81%, respectively. Errors within 1 mm ranged between 28.50-98.90% (control group) and 55.10-99.6% (experimental group) with mean errors of 67.36% and 85.60%, respectively. The largest RMSDs were 1.20 mm in the anteroposterior direction and 6.78° in pitch orientation for the experimental group and 1.78 mm in the anteroposterior direction and 6.04° in pitch orientation for the control group. A statistically significant difference between the two groups was observed for errors measured within 1 mm (P=0.047) and for yaw (P=0.003). No postoperative complications were observed in either group.
Using CAD/CAM with additional MR technology in genioplasty improved the repositioning accuracy of the chin bone fragment and plate placement, with statistically significant improvements in specific spatial directions. This combination of CAD/CAM and MR technology allows for intraoperative spatial verification of fragment movement according to preoperative VSP, which significantly contributes surgical precision.
颏成形术作为正颌外科手术的一部分，用于矫正颌骨畸形。该手术在骨合成准确性方面存在挑战。本研究旨在评估使用计算机辅助设计/计算机辅助制造（CAD/CAM）结合三维（3D）可打印生物材料以及混合现实（MR）技术（头戴式显示器（Microsoft HoloLens 2）和注册标记）进行颏成形术时术前规划的精度。
26例患者接受颏成形术，其中仅使用CAD/CAM设备的为对照组（n = 10），使用CAD/CAM并附加MR技术的为实验组（n = 16）。基于虚拟手术规划（VSP）创建CAD/CAM设备，并使用Microsoft HoloLens 2将基于VSP数据创建的MR全息图投影到手术区域。术后，将规划模型与术后计算机断层扫描（CT）图像进行比较，使用均方根偏差（RMSD）和布兰德-奥特曼方法测量3D表面以及位置和旋转的差异。两项分析均采用盲法。
2mm以内的平均3D表面分析误差在对照组为62.20 - 100.00%，在实验组为99.30 - 100.00%，平均误差分别为92.12%和99.81%。1mm以内的误差在对照组为28.50 - 98.90%，在实验组为55.10 - 99.6%），平均误差分别为67.36%和85.60%。实验组在前后方向上的最大RMSD为1.20mm，俯仰方向为6.78°；对照组在前后方向上的最大RMSD为1.78mm，俯仰方向为6.04°。两组在1mm以内测量的误差（P = 0.047）和偏航（P = 0.003）方面存在统计学显著差异。两组均未观察到术后并发症。
在颏成形术中使用CAD/CAM并附加MR技术可提高颏骨碎片和钢板放置的重新定位准确性，在特定空间方向上有统计学显著改善。CAD/CAM与MR技术的这种结合允许根据术前VSP在术中对碎片移动进行空间验证，这对手术精度有显著贡献。
