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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
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Mandibular autorotation: a critical virtual parameter in clinical decision-making regarding maxilla-first versus
F O Andriola1, Y Weinberg2, L Grosjean3
1Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium.
International Journal of Oral and Maxillofacial Surgery
|February 13, 2024
Summary
Mandibular autorotation in intermediate splint design impacts accuracy. This study guides choosing between maxilla-first or mandible-first sequences in orthognathic surgery based on specific movements and deformities to minimize errors.
Area of Science:
- Orthognathic Surgery
- Virtual Surgical Planning
- Biomedical Engineering
Background:
- Mandibular autorotation during intermediate splint design can lead to significant transfer errors and reduced accuracy in orthognathic surgery.
- Optimizing intermediate splint design is crucial for predictable surgical outcomes.
Purpose of the Study:
- To evaluate mandibular autorotation in maxilla-first versus mandible-first sequences for intermediate splint design.
- To guide clinical decision-making on the most suitable sequence based on patient-specific factors.
- To identify orthognathic movements and maxillofacial deformities influencing autorotation requirements.
Main Methods:
- Analysis of 3D virtual surgical planning data from 194 patients undergoing orthognathic surgery.
- Subgroup analyses using Kruskal-Wallis test and post-hoc pairwise comparisons.
- Evaluation of specific movements (Le Fort I vertical/sagittal changes, cant correction) and deformities (Class II, Class III, anterior open bite).
Main Results:
- Maxilla-first sequence is indicated for bimaxillary osteotomies involving Le Fort I posterior intrusion, anterior open bite, and skeletal Class III deformities.
- Mandible-first sequence is recommended for Le Fort I global extrusion, particularly with maxillary cant correction.
- Specific orthognathic movements and deformities necessitate varying degrees of mandibular autorotation.
Conclusions:
- The choice between maxilla-first and mandible-first sequences should consider the planned orthognathic movements and the type of maxillofacial deformity.
- Understanding autorotation requirements aids in selecting the optimal surgical sequence, thereby enhancing the accuracy of intermediate splint design.
- This research provides valuable insights for improving virtual planning and surgical execution in complex orthognathic cases.
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