Mandible-First and Maxilla-First Sequencing in Virtual Surgical Planning for Orthognathic Surgery: Comparison of Planned and Actual Outcomes.

Ece Bozok, Abdullah Ozel, Emine Fulya Akkoyun, Elvan Dolanmaz
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Abstract

Background: Recent studies have shown that virtual planning for orthognathic surgery is an accurate and repeatable method. It is also a fact that surgical sequence can affect the results in terms of accuracy. Various studies stated that both approaches offer comparable results when properly planned and implemented; however, further clinical studies are still needed. This study aims to evaluate the effect of virtual surgical planning (VSP) on surgical outcomes and whether it is affected by mandible-first or maxilla-first approaches. Methods: This study analyzed data from 45 patients who underwent orthognathic surgery due to dentofacial deformity. Six of these patients underwent single-jaw orthognathic surgery, and 39 underwent bimaxillary orthognathic surgery (Maxilla-first group: 21, mandible-first group: 18). The displacements of specific landmarks were assessed by comparing preoperative and postoperative conventional computed tomographies with VSP data. Results: This study showed a statistically significant relationship between the measurements made with the 2 methods (r = .944; P = .0001). The fact that the intra-class correlation coefficient value is statistically significant and relatively high and that most of the differences in the Bland-Altman chart fall between the limits of compliance indicates a correlation between the virtual plan and surgical outcomes. In addition, in vertical measurements, the absolute mean difference of the B point and the Pogonion in the Maxilla-first group were statistically significantly higher than in the Mandible-first group (P = .038, P = .011). Conclusions: Our findings corroborate the high accuracy of the VSP reported in previous studies and also demonstrate that VSP with both maxilla-first and mandible-first sequencing achieves high accuracy in the sagittal and coronal planes. Although virtual planning significantly influences accurate surgical outcomes, it is not the sole determinant. Factors like condylar positioning and fixation methods can also impact the final results.

正颌外科手术虚拟手术规划中的 "下颌先行 "和 "上颌先行 "排序:计划结果与实际结果的比较。
背景:最近的研究表明,虚拟规划正颌外科手术是一种准确且可重复的方法。事实上,手术顺序也会影响结果的准确性。多项研究表明,如果计划和实施得当,这两种方法的效果相当,但仍需进一步的临床研究。本研究旨在评估虚拟手术规划(VSP)对手术效果的影响,以及下颌先露法和上颌先露法对手术效果的影响。方法:本研究分析了 45 名因颌面部畸形而接受正颌手术的患者的数据。其中 6 名患者接受了单颌正颌手术,39 名患者接受了双颌正颌手术(上颌先行组:21 人,下颌先行组:18 人)。通过比较术前和术后的传统计算机断层扫描与 VSP 数据,评估了特定地标的位移情况。结果:研究表明,两种方法的测量结果之间存在显著的统计学关系(r = .944;P = .0001)。类内相关系数具有统计学意义且相对较高,布兰-阿尔特曼图中的大部分差异都在符合性界限之间,这表明虚拟计划与手术结果之间存在相关性。此外,在垂直测量中,上颌骨先行组的 B 点和 Pogonion 的绝对平均差在统计学上明显高于下颌骨先行组(P = .038, P = .011)。结论:我们的研究结果证实了之前研究中报道的 VSP 的高准确性,同时也证明了上颌骨先行和下颌骨先行排序的 VSP 在矢状面和冠状面上都能达到很高的准确性。虽然虚拟规划对准确的手术结果有很大影响,但它并不是唯一的决定因素。髁突定位和固定方法等因素也会影响最终结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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