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KJO Korean Journal of Orthodontics

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eISSN 2005-372X
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Korean J Orthod

Published online February 17, 2021

Copyright © The Korean Association of Orthodontists.

Accurate transfer of surgical plan in bimaxillary orthognathic surgery using computer-aided intraoperative navigation

Chen Chena, Ningning Sunb, Chunmiao Jiangc, Yanshan Liua, Jian Suna,d

aDepartment of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, China
bDepartment of Emergency Intensive Care Unit, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, China
cDepartment of Orthodontics, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, China
dDental Digital Medicine & 3D Printing Engineering Laboratory of Qingdao University, Qingdao, Shandong, China

Correspondence to:Jian Sun.
Professor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266000, Shandong, China.
Tel +86-0532-82911359 e-mail sunjianqy@126.com.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective: This study aimed to examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery, by comparing preoperative planning and postoperative outcome. Methods: The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. During the surgery, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the LeFort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Real-time Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcome were calculated. Results: The mean linear difference was 0.79 mm (0.62 mm for the maxilla and 0.88 mm for the mandible); the overall mean angular difference was 1.20°. The observed difference of the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was <1 mm in 40 cases. Conclusions: This study demonstrated the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method to transfer the surgical plan during operation.

Keywords: Orthognathic surgery, Virtual surgery planning, Computer-assisted surgery, Intraoperative navigation

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Korean J Orthod

Published online February 17, 2021

Copyright © The Korean Association of Orthodontists.

Accurate transfer of surgical plan in bimaxillary orthognathic surgery using computer-aided intraoperative navigation

Chen Chena, Ningning Sunb, Chunmiao Jiangc, Yanshan Liua, Jian Suna,d

aDepartment of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, China
bDepartment of Emergency Intensive Care Unit, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, China
cDepartment of Orthodontics, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, China
dDental Digital Medicine & 3D Printing Engineering Laboratory of Qingdao University, Qingdao, Shandong, China

Correspondence to:Jian Sun.
Professor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266000, Shandong, China.
Tel +86-0532-82911359 e-mail sunjianqy@126.com.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective: This study aimed to examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery, by comparing preoperative planning and postoperative outcome. Methods: The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. During the surgery, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the LeFort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Real-time Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcome were calculated. Results: The mean linear difference was 0.79 mm (0.62 mm for the maxilla and 0.88 mm for the mandible); the overall mean angular difference was 1.20°. The observed difference of the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was <1 mm in 40 cases. Conclusions: This study demonstrated the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method to transfer the surgical plan during operation.

Keywords: Orthognathic surgery, Virtual surgery planning, Computer-assisted surgery, Intraoperative navigation