Navigation in Orthognathic Surgery: 3D Accuracy
18 November 2015 (online)
This article aims to determine the absolute accuracy of maxillary repositioning during orthognathic surgery according to simulation-guided navigation, that is, the combination of navigation and three-dimensional (3D) virtual surgery. We retrospectively studied 15 patients treated for asymmetric dentofacial deformities at the Oral and Maxillofacial Surgery Unit of the S.Orsola-Malpighi University Hospital in Bologna, Italy, from January 2010 to January 2012. Patients were scanned with a cone-beam computed tomography before and after surgery. The virtual surgical simulation was realized with a dedicated software and loaded on a navigation system to improve intraoperative reproducibility of the preoperative planning. We analyzed the outcome following two protocols: (1) planning versus postoperative 3D surface analysis; (2) planning versus postoperative point-based analysis. For 3D surface comparison, the mean Hausdorff distance was measured, and median among cases was 0.99 mm. Median reproducibility < 1 mm was 61.88% and median reproducibility < 2 mm was 85.46%. For the point-based analysis, with sign, the median distance was 0.75 mm in the frontal axis, −0.05 mm in the caudal–cranial axis, −0.35 mm in the lateral axis. In absolute value, the median distance was 1.19 mm in the frontal axis, 0.59 mm in the caudal–cranial axis, and 1.02 mm in the lateral axis. We suggest that simulation-guided navigation makes accurate postoperative outcomes possible for maxillary repositioning in orthognathic surgery, if compared with the surgical computer-designed project realized with a dedicated software, particularly for the vertical dimension, which is the most challenging to manage.