Korean J Orthod.  2021 Sep;51(5):321-328. 10.4041/kjod.2021.51.5.321.

Accurate transfer of bimaxillary orthognathic surgical plans using computer-aided intraoperative navigation

• Chen C
• Sun N
• Jiang C
• Liu Y
• Sun J

• KMID: 2520372
• DOI: http://doi.org/10.4041/kjod.2021.51.5.321

Abstract

Objective
To examine the accuracy of computer-aided intraoperative navigation (Ci-Navi) in bimaxillary orthognathic surgery by comparing preoperative planning and postoperative outcome.
Methods
The study comprised 45 patients with congenital dentomaxillofacial deformities who were scheduled to undergo bimaxillary orthognathic surgery. Virtual bimaxillary orthognathic surgery was simulated using Mimics software. Intraoperatively, a Le Fort I osteotomy of the maxilla was performed using osteotomy guide plates. After the Le Fort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible, the mobilized maxilla and the distal mandibular segment were fixed using an occlusal splint, forming the maxillomandibular complex (MMC). Realtime Ci-Navi was used to lead the MMC in the designated direction. Osteoplasty of the inferior border of the mandible was performed using Ci-Navi when facial symmetry and skeletal harmony were of concern. Linear and angular distinctions between preoperative planning and postoperative outcomes were calculated.
Results
The mean linear difference was 0.79 mm (maxilla: 0.62 mm, mandible: 0.88 mm) and the overall mean angular difference was 1.20°. The observed difference in the upper incisor point to the Frankfort horizontal plane, midfacial sagittal plane, and coronal plane was < 1 mm in 40 cases.
Conclusions
This study demonstrates the role of Ci-Navi in the accurate positioning of bone segments during bimaxillary orthognathic surgery. Ci-Navi was found to be a reliable method for the accurate transfer of the surgical plan during an operation.

Keyword

Orthognathic surgery; Virtual surgery planning; Computer-assisted surgery; Intraoperative navigation

Figure

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  Figure 1 Registration of the navigation system. Registration landmarks were selected (A) and patient-to-image registration was performed (B).

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  Figure 2 Le Fort I osteotomy. A, The osteotomy templates were fixed to the anterior wall of the maxilla using screws. B, A Le Fort I osteotomy was performed with guidance templates, and the osteotomy templates had been removed.

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  Figure 3 Repositioning of the maxillomandibular complex (MMC). A, Actual position of the MMC is displayed on the screen instantaneously. B, Repositioning of the MMC during the operation under the guidance of a navigation probe.

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  Figure 4 Osteoplasty of the inferior border of the mandible. This procedure was performed under the guidance of specially assembled navigation probes, and the surgical outcome was displayed on the screen. A–C, Assembling and registering of the specialized navigation probe. D, The inferior border of the mandible was modified under the guidance of the navigation probe. E, The result was displayed on the screen.

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  Figure 5 Evaluation. The preoperative plan (A) and postoperative outcome (B) were superimposed to construct a composite skull model (C). The linear and angular differences were measured using selected reference landmarks and planes (D, E).

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