Enhanced Surgical Outcomes in Patients With Skeletal Class III Facial Asymmetry by 3-Dimensional Surgical Simulation

Ellen Wen-Ching Ko; Cheng-Hui Lin; Ying-An Chen; Yu-Ray Chen

doi:10.1016/j.joms.2017.09.009

Enhanced Surgical Outcomes in Patients With Skeletal Class III Facial Asymmetry by 3-Dimensional Surgical Simulation

J Oral Maxillofac Surg. 2018 May;76(5):1073-1083. doi: 10.1016/j.joms.2017.09.009. Epub 2017 Sep 19.

Authors

Ellen Wen-Ching Ko¹, Cheng-Hui Lin², Ying-An Chen³, Yu-Ray Chen⁴

Affiliations

¹ Professor, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. Electronic address: ellenko@cgmh.org.tw.
² Assistant Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
³ Attending Staff, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁴ Professor, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan; Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.

PMID: 29031529
DOI: 10.1016/j.joms.2017.09.009

Abstract

Purpose: With the advance of image fusion techniques, the creation of 3-dimensional (3D) virtual head and 3D surgical simulations has provided previews of surgical procedures. The aim of this study was to investigate the surgical outcomes in patients receiving orthognathic surgery (OGS) with the guidance of 3D computer-assisted surgical simulation.

Patients and methods: The study included 34 consecutive patients (15 men and 19 women; age, 18.1 to 33.0 yr) with skeletal Class III facial asymmetry who underwent bimaxillary OGS. One-week postoperative cone-beam computed tomographic craniofacial images (Ta) were constructed and superimposed on preoperative simulated virtual images (Ts) at the cranial base and surfaces of the frontal and periorbital regions. The 3D cephalometric landmarks were measured relative to 3 reference planes. The outcomes among different experience levels of surgeons also were compared.

Results: Although the mean values between Ta and Ts were small, statistical differences were observed in the center of maxillary and mandibular incisors and the B point relative to the midline and in the maxillary first molar in vertical distances, sagittal dentoskeletal dimensions, and pitch angles. The root mean square deviations (RMSD_L) of measurement variables relative to center landmark accuracy were 1.5 and less than 2 mm at the maxilla and mandible, respectively. RMSD_L greater than 2 mm was located at the maxillary first molar in the vertical distance and in the sagittal dimension at the anterior nasal spine and B point. Variables related to centering the midline structures were highly inter-related. The roll angle deviation was associated with centering the midline landmarks. The yaw angle deviation was not associated with midline correction.

Conclusion: With guidance from 3D surgical simulation, surgeons could achieve similar outcomes to correct facial asymmetry regardless of their years of practice.

MeSH terms

Adolescent
Adult
Anatomic Landmarks
Computer Simulation
Cone-Beam Computed Tomography*
Facial Asymmetry / diagnostic imaging
Facial Asymmetry / surgery*
Female
Humans
Imaging, Three-Dimensional*
Male
Maxilla / diagnostic imaging
Maxilla / surgery
Orthognathic Surgical Procedures / methods*
Osteotomy, Le Fort / methods*
Surgery, Computer-Assisted / methods*
Treatment Outcome
Young Adult