Computer-assisted orthognathic surgery: waferless maxillary positioning, versatility, and accuracy of an image-guided visualisation display

Abstract

There may well be a shift towards 3-dimensional orthognathic surgery when virtual surgical planning can be applied clinically. We present a computer-assisted protocol that uses surgical navigation supplemented by an interactive image-guided visualisation display (IGVD) to transfer virtual maxillary planning precisely. The aim of this study was to analyse its accuracy and versatility in vivo. The protocol consists of maxillofacial imaging, diagnosis, planning of virtual treatment, and intraoperative surgical transfer using an IGV display. The advantage of the interactive IGV display is that the virtually planned maxilla and its real position can be completely superimposed during operation through a video graphics array (VGA) camera, thereby augmenting the surgeon's 3-dimensional perception. Sixteen adult class III patients were treated with by bimaxillary osteotomy. Seven hard tissue variables were chosen to compare (ΔT1-T0) the virtual maxillary planning (T0) with the postoperative result (T1) using 3-dimensional cephalometry. Clinically acceptable precision for the surgical planning transfer of the maxilla (<0.35 mm) was seen in the anteroposterior and mediolateral angles, and in relation to the skull base (<0.35°), and marginal precision was seen in the orthogonal dimension (<0.64 mm). An interactive IGV display complemented surgical navigation, augmented virtual and real-time reality, and provided a precise technique of waferless stereotactic maxillary positioning, which may offer an alternative approach to the use of arbitrary splints and 2-dimensional orthognathic planning.

Keywords: 3D-cephalometry; Interactive image-guided-visualization-display; Orthognathic surgery; Surgical navigation; Virtual orthognathic planning.