The use of a custom-made virtual template for corrective surgeries of asymmetric patients: proof of principle and a multi-center end-user survey

Int J Comput Assist Radiol Surg. 2019 Mar;14(3):537-544. doi: 10.1007/s11548-018-1858-8. Epub 2018 Sep 24.


Aim: To evaluate the utility of an individualized template for corrective surgeries for patients suffering from mandibular asymmetry.

Materials and method: Twenty patients with history of favorable clinical outcome of the correction of their mandibular asymmetry were chosen. CBCTs were taken before and 6 weeks postoperative using NewTom 3G. Each volume is mirrored and registered on the cranial base. Surface models for the mandible and its registered mirror were used to compute a template using deformable fluid registration. Surgery was simulated based of the resulting template. A multi-center survey using "Qualtrics" was conducted to gain clinical feedback of 20 surgeons/orthodontists comparing treatment outcomes.

Results: Twenty-three clinicians participated. More clinicians rated simulated outcome to be "Good," whereas the actual surgical outcomes were rated as "fair" and "poor." This was true for regional appraisal for the chin, Rami, and body of the mandible as well as the overall assessment of the outcome of surgeries. The gains of computer-assisted simulation tend to be greater for difficult cases especially for the body of the mandible, then the chin, and then the Ramus correction.

Conclusions: This approach has the potential to optimize and increase the predictability of the outcome of craniofacial corrective surgeries for asymmetric patients.

Keywords: Asymmetry; Template; Virtual surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Computer Simulation
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Mandible / abnormalities*
  • Mandible / diagnostic imaging
  • Mandible / surgery*
  • Observer Variation
  • Orthodontists
  • Random Allocation
  • Software
  • Surgeons
  • Surgery, Computer-Assisted
  • Surveys and Questionnaires