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, 3 (2), e307
eCollection

Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods Versus 3D Surgical Planning

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Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods Versus 3D Surgical Planning

Jeffrey A Hammoudeh et al. Plast Reconstr Surg Glob Open.

Abstract

Background: Orthognathic surgery has traditionally been performed using stone model surgery. This involves translating desired clinical movements of the maxilla and mandible into stone models that are then cut and repositioned into class I occlusion from which a splint is generated. Model surgery is an accurate and reproducible method of surgical correction of the dentofacial skeleton in cleft and noncleft patients, albeit considerably time-consuming. With the advent of computed tomography scanning, 3D imaging and virtual surgical planning (VSP) have gained a foothold in orthognathic surgery with VSP rapidly replacing traditional model surgery in many parts of the country and the world. What has yet to be determined is whether the application and feasibility of virtual model surgery is at a point where it will eliminate the need for traditional model surgery in both the private and academic setting.

Methods: Traditional model surgery was compared with VSP splint fabrication to determine the feasibility of use and accuracy of application in orthognathic surgery within our institution.

Results: VSP was found to generate acrylic splints of equal quality to model surgery splints in a fraction of the time. Drawbacks of VSP splint fabrication are the increased cost of production and certain limitations as it relates to complex craniofacial patients.

Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.

Figures

Fig. 1.
Fig. 1.
Maxillary and mandibular stone models.
Fig. 2.
Fig. 2.
Maxillary cast markings.
Fig. 3.
Fig. 3.
Maxillary cast segmentation.
Fig. 4.
Fig. 4.
Mounted maxillary and mandibular casts with final acrylic splint.
Fig. 5.
Fig. 5.
Acrylic splints from traditional model surgery: (A) intermediate splint, (B) final splint, and (C) final splint mounted within intermediate splint.
Fig. 6.
Fig. 6.
VSP maxillary movement with bony overlap.
Fig. 7.
Fig. 7.
Three-piece LeFort I for intermediate position.
Fig. 8.
Fig. 8.
VSP mandibular movement with bony overlap.
Fig. 9.
Fig. 9.
Three-piece LeFort I and BSSO for final position.
Fig. 10.
Fig. 10.
Proposed algorithm for tradition model surgery versus virtual surgical planning.

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