Patient-specific implants in minimally invasive orthognathic surgery: A case series

This study aimed to evaluate the accuracy of maxillary repositioning using patient-specific implants (PSI) adapted for minimally invasive orthognathic surgery (MIOS), employing a simplified two-plate fixation protocol. Although all patients underwent bimaxillary orthognathic surgery, quantitative accuracy analysis was limited to the maxilla. This retrospective study included 20 patients treated with PSI tailored for MIOS. The surgical protocol involved limited soft tissue dissection and maxillary fixation using only two plates. Postoperative accuracy was assessed through computed tomography and voxel-based comparison with the virtual surgical plan. Discrepancies were measured in three linear axes and cant correction. Statistical analysis included Bland-Altman plots, effect sizes, and intraclass correlation coefficients (ICCs). All procedures were completed without intraoperative complications. Discrepancies between planned and postoperative positions ranged from 0.02 mm to 0.31 mm. ICCs exceeded 0.82 across all variables, with cant correction ICCs of 0.98 and 0.99. Effect sizes were negligible to small, and Bland-Altman analysis revealed no systematic bias. Customized PSI can be effectively adapted for use in MIOS protocols. Despite a reduced fixation strategy, high accuracy and reproducibility were achieved. These findings support the use of simplified PSI workflows as a precise and less invasive alternative in modern orthognathic surgery.