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CC BY 4.0 · Arch Plast Surg 2023; 50(03): 254-263
DOI: 10.1055/a-2058-8108
Pediatric/Craniomilofacial/Head & Neck
Original Article

Three-Dimensional Evaluation of Skeletal Stability following Surgery-First Orthognathic Approach: Validation of a Simple and Effective Method

Nabil M. Mansour 
1   Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
,
Mohamed E. Abdelshaheed 
1   Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
,
Ahmed H. El-Sabbagh 
1   Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
,
Ahmed M. Bahaa El-Din
1   Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Mansoura University, Mansoura, Egypt
,
Young Chul Kim 
2   Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
,
Jong-Woo Choi 
2   Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
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Abstract

Background The three-dimensional (3D) evaluation of skeletal stability after orthognathic surgery is a time-consuming and complex procedure. The complexity increases further when evaluating the surgery-first orthognathic approach (SFOA). Herein, we propose and validate a simple time-saving method of 3D analysis using a single software, demonstrating high accuracy and repeatability.

Methods This retrospective cohort study included 12 patients with skeletal class 3 malocclusion who underwent bimaxillary surgery without any presurgical orthodontics. Computed tomography (CT)/cone-beam CT images of each patient were obtained at three different time points (preoperation [T0], immediately postoperation [T1], and 1 year after surgery [T2]) and reconstructed into 3D images. After automatic surface-based alignment of the three models based on the anterior cranial base, five easily located anatomical landmarks were defined to each model. A set of angular and linear measurements were automatically calculated and used to define the amount of movement (T1–T0) and the amount of relapse (T2–T1). To evaluate the reproducibility, two independent observers processed all the cases, One of them repeated the steps after 2 weeks to assess intraobserver variability. Intraclass correlation coefficients (ICCs) were calculated at a 95% confidence interval. Time required for evaluating each case was recorded.

Results Both the intra- and interobserver variability showed high ICC values (more than 0.95) with low measurement variations (mean linear variations: 0.18 mm; mean angular variations: 0.25 degree). Time needed for the evaluation process ranged from 3 to 5 minutes.

Conclusion This approach is time-saving, semiautomatic, and easy to learn and can be used to effectively evaluate stability after SFOA.

Keywords

orthognathic surgery - surgery-first - three-dimensional - 3D evaluation - skeletal stability

Authors' Contributions

Conceptualization, data curation, formal analysis, methodology, visualization: N.M.M., M.E.A., A.M.B.E.-D., A.H.E.-S., Y.C.K., and J.W.C. Project administration: N.M.M., A.H.E.-S., Y.C.K., J.W.C. Writing-original draft: N.M.M. and M.E.A. Writing-review and editing: N.M.M., Y.C.K., A.H.E.-S., and J.W.C.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committee (registration number: S2022-2275-0001).


Patient Consent

Written patient consent was obtained for publication and academic purposes.


Supplementary Material



Publication History

Received: 14 October 2022

Accepted: 03 March 2023

Accepted Manuscript online:
21 March 2023

Article published online:
29 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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