Ortho-OPD: An Automatic Osteotomy Planes Design Model for Orthognathic Surgery Based on Deep Learning

Orthognathic surgery is applied to restore esthetical facial profile and functional occlusion for patients with dentofacial deformity. Virtual surgical planning (VSP) is indispensable for precise and individualized treatment. Manually designing osteotomy planes is time-consuming and highly experience-dependent. This study aimed to develop and validate an automatic osteotomy plane design method based on deep learning. Methods: A deep learning model, Ortho-OPD (orthognathic osteotomy planes designer), was proposed, consisting of a segmentation network and the random sample consensus (RANSAC) algorithm. The segmentation network was based on a convolutional neural network (CNN), orthognathic segmenting the craniomaxillofacial (CMF) CT data. Osteotomy planes were then defined by the RANSAC algorithm. Ortho-OPD was trained on 71 samples and tested on 31 cases. The performance was evaluated quantitatively and qualitatively. Results: Ortho-OPD functioned smoothly and all cases were successfully performed. The 3D boundary-sensitive loss was employed to optimize precision. Evaluation metrics included accuracy and clinical efficiency.The mean dice similarity coefficient (DSC) was 0.92 $\pm$ 0.032 in CMF segmentation. Ortho-OPD showcased excellent productivity, taking an average of about 9 seconds to complete virtual bimaxillary osteotomy compared to manual work. The angular errors between the predicted planes and ground truth planes, plus the shortest distance from the neural tube or the adjacent apical points to predicted planes, were examined, indicating no significant difference and reliability for preserving vital anatomical structures. Overall, the automatic osteotomy plane design from raw CT data was realized using Ortho-OPD, composed of CNN and RANSAC, providing an efficient and ideal alternative in orthognathic osteotomy planning.