Accuracy of a Computer-Aided Surgical Simulation Protocol for Orthognathic Surgery: A Prospective Multicenter Study

被引:311
作者
Hsu, Sam Sheng-Pin [1 ]
Gateno, Jaime
Bell, R. Bryan
Hirsch, David L.
Markiewicz, Michael R.
Teichgraeber, John F.
Zhou, Xiaobo [2 ]
Xia, James J. [1 ]
机构
[1] Methodist Hosp, Dept Oral & Maxillofacial Surg, Res Inst, Houston, TX 77030 USA
[2] Methodist Hosp, Dept Radiol, Res Inst, Houston, TX 77030 USA
基金
美国国家卫生研究院;
关键词
NATURAL HEAD POSITION; FACE-BOW TRANSFER; CRANIOMAXILLOFACIAL DEFORMITIES; CLINICAL FEASIBILITY; SCAN PROCEDURE; SKULL MODEL; SYSTEM; TOMOGRAPHY; NAVIGATION; CEPHALOMETRY;
D O I
10.1016/j.joms.2012.03.027
中图分类号
R78 [口腔科学];
学科分类号
1003 ;
摘要
Purpose: The purpose of this prospective multicenter study was to assess the accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery. Materials and Methods: The accuracy of the CASS protocol was assessed by comparing planned outcomes with postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computer-generated surgical splints were used for all patients. For the genioplasty, 1 center used computer-generated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were used without the chin templates for the remaining patients. The primary outcome measurements were the linear and angular differences for the maxilla, mandible, and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were the maxillary dental midline difference between the planned and postoperative positions and the linear and angular differences of the chin segment between the groups with and without the use of the template. The latter were measured when the planned and postoperative models were registered at the mandibular body. Statistical analyses were performed, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method for assessing measurement agreement. Results: In the primary outcome measurements, there was no statistically significant difference among the 3 centers for the maxilla and mandible. The largest RMSDs were 1.0 mm and 1.5 degrees for the maxilla and 1.1 mm and 1.8 degrees for the mandible. For the chin, there was a statistically significant difference between the groups with and without the use of the chin template. The chin template group showed excellent accuracy, with the largest positional RMSD of 1.0 mm and the largest orientation RMSD of 2.2 degrees. However, larger variances were observed in the group not using the chin template. This was significant in the anteroposterior and superoinferior directions and the in pitch and yaw orientations. In the secondary outcome measurements, the RMSD of the maxillary dental midline positions was 0.9 mm. When registered at the body of the mandible, the linear and angular differences of the chin segment between the groups with and without the use of the chin template were consistent with the results found in the primary outcome measurements. Conclusions: Using this computer-aided surgical simulation protocol, the computerized plan can be transferred accurately and consistently to the patient to position the maxilla and mandible at the time of surgery. The computer-generated chin template provides greater accuracy in repositioning the chin segment than the intraoperative measurements. (C) 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71: 128-142, 2013
引用
收藏
页码:128 / 142
页数:15
相关论文
共 35 条
[1]   Computer Planning and Intraoperative Navigation in Orthognathic Surgery [J].
Bell, R. Bryan .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2011, 69 (03) :592-605
[2]  
Bell WH., 1992, Modern practice in orthognathic and reconstructive surgery
[3]   STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT [J].
BLAND, JM ;
ALTMAN, DG .
LANCET, 1986, 1 (8476) :307-310
[4]   Computerized cephalometric evaluation of orthognathic surgical precision and stability in relation to maxillary superior repositioning combined with mandibular advancement or setback [J].
Donatsky, O ;
BjornJorgensen, J ;
HolmqvistLarsen, M ;
Hillerup, S .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 1997, 55 (10) :1071-1079
[5]   ACCURACY OF FACE-BOW TRANSFER - EFFECT ON SURGICAL PREDICTION AND POSTSURGICAL RESULT [J].
ELLIS, E ;
THARANON, W ;
GAMBRELL, K .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 1992, 50 (06) :562-567
[6]   A new technique for the creation of a computerized composite skull model [J].
Gateno, J ;
Xia, J ;
Teichgraeber, JF ;
Rosen, A .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2003, 61 (02) :222-227
[7]   The precision of computer-generated surgical splints [J].
Gateno, J ;
Xia, J ;
Teichgraeber, JF ;
Rosen, A ;
Hultgren, B ;
Vadnais, T .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2003, 61 (07) :814-817
[8]   A comparison of 3 methods of face-bow transfer recording: Implications for orthognathic surgery [J].
Gateno, J ;
Forrest, KK ;
Camp, B .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2001, 59 (06) :635-640
[9]  
Gateno J, 2011, J ORAL MAXILLOFAC SU
[10]   Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex craniomaxillofacial deformities [J].
Gateno, Jaime ;
Xia, James J. ;
Teichgraeber, John F. ;
Christensen, Andrew M. ;
Lemoine, Jeremy J. ;
Liebschner, Michael A. K. ;
Gliddon, Michael J. ;
Briggs, Michaelanne E. .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2007, 65 (04) :728-734