Midfacial Advancement Line-A Comparative Evaluation of a New Measurement Method in Orthognathic Surgery

Katrin Willinger; Julia Cede; Godoberto Guevara-Rojas; Klaus Sinko; Michael Figl; Kurl Schicho; Stefan Nemec; Clemens Klug

doi:10.1016/j.joms.2019.10.013

Midfacial Advancement Line-A Comparative Evaluation of a New Measurement Method in Orthognathic Surgery

J Oral Maxillofac Surg. 2020 Feb;78(2):286.e1-286.e9. doi: 10.1016/j.joms.2019.10.013. Epub 2019 Oct 28.

Authors

Katrin Willinger¹, Julia Cede², Godoberto Guevara-Rojas³, Klaus Sinko⁴, Michael Figl⁵, Kurl Schicho⁶, Stefan Nemec⁷, Clemens Klug⁸

Affiliations

¹ Radiographer and Researcher, Department of Craniofacial, Maxillofacial, and Oral Surgery, University Clinic of Craniofacial and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: n09501464@students.meduniwien.ac.at.
² Resident, Department of Craniofacial, Maxillofacial, and Oral Surgery, University Clinic of Craniofacial and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
³ Researcher, University of Applied Sciences, FH Campus Wien, Wien, Austria.
⁴ Orthodontist, Department of Craniofacial, Maxillofacial, and Oral Surgery, University Clinic of Craniofacial and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
⁵ Professor and Physicist, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
⁶ Professor and Senior Researcher, Department of Craniofacial, Maxillofacial, and Oral Surgery, University Clinic of Craniofacial and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
⁷ Professor and Radiologist, University Clinic of Radiology, Medical University of Vienna, Vienna, Austria.
⁸ Professor and Senior Physician, Department of Craniofacial, Maxillofacial, and Oral Surgery, University Clinic of Craniofacial and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.

PMID: 31778641
DOI: 10.1016/j.joms.2019.10.013

Abstract

Purpose: In planning intraoral quadrangular Le Fort II osteotomy (IQLFIIO), simulation of hard and soft tissue changes will be important at the infraorbital, Le Fort I, and incisor level. The aim of our study was to evaluate a new method for visualization and quantification.

Materials and methods: Three different methods of quantification were compared: the point-to-point (PTP) measurement, which has been viewed as the reference standard; part comparison analysis (PCA); and a new method, the midfacial advancement line (MFAL) measurement. We performed a measurement comparison study using the Bland-Altman method to measure agreement and enrolled patients with midfacial deficiency and Class III malocclusion who had undergone IQLFIIO. The primary predictor variable was the method of measurement. The primary outcome variable was the amount of midfacial advancement. We also investigated the time required, visualization quality, and interobserver agreement.

Results: The sample included 12 subjects with a mean age of 21.6 years; 7 patients were male. The PTP and MFAL showed no significant observer dependence. The advancement measured with PTP and MFAL showed no significant differences. However, the advancement measured using MFAL and PCA showed a significant difference. The highest rating of visualization was found for MFAL. The time requirements were similar for all 3 methods.

Conclusions: Our results have shown that the MFAL is a suitable method for visualization and quantification of soft and hard tissue changes at all 3 face levels in 1 image. It could be a valuable tool for virtual planning of midfacial advancement surgery.

MeSH terms

Adult
Cephalometry
Face / anatomy & histology
Humans
Male
Malocclusion, Angle Class III*
Maxilla
Orthognathic Surgery*
Orthognathic Surgical Procedures*
Osteotomy, Le Fort
Treatment Outcome
Young Adult