From “Empirical Surgery” to “Precision Surgery”: establishment and clinical application of precision orthognathic surgery system

doi:10.7518/hxkq.2023.2023152

Abstract

Abstract:

Orthognathic surgery, which involve osteotomy and repositioning of the maxillomandibular complex, has recently emerged as a crucial method of correcting dentofacial deformities. The optimal placement of the maxillomandibular complex holds utmost significance during orthognathic surgery because it directly affects the surgical outcome. To accurately achieve the ideal position of the maxillomandibular complex, with the rapid advancements in digital surgery and 3D-printing technology, orthognathic surgery has entered an era of “Precision Surgery” from the pervious “Empirical Surgery.” This article provides comprehensive insights into our extensive research and exploration of the treatment modality known as “precision orthognathic surgery” over the years. We also present the technical system and application in“Ortho+X” treatment modality to offer valuable references and assistance to our colleagues in the field.

Key words: precision orthognathic surgery, dentofacial deformities, virtual surgical plan, 3D-printed osteotomy guide, 3D-printed patient-specific implants

CLC Number:

R 782.2

Wang Xudong, Wei Hongpu, Li Biao.. From “Empirical Surgery” to “Precision Surgery”: establishment and clinical application of precision orthognathic surgery system[J]. West China Journal of Stomatology, 2023, 41(5): 491-501.

Figures/Tables 7

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References 45

1	董家鸿, 张宁. 精准外科[J]. 中华外科杂志, 2015, 53(5): 321-323.
	Dong JH, Zhang N. Precision surgery[J]. Chin J Surg, 2015, 53(5): 321-323.
2	董家鸿, 黄志强. 精准肝切除—21世纪肝脏外科新理念[J]. 中华外科杂志, 2009, 47(21): 1601-1605.
	Dong JH, Huang ZQ. Precise liver resection—new concept of liver surgery in 21st century[J]. Chin J Surg, 2009, 47(21): 1601-1605.
3	沈国芳. 数字化技术与正颌外科[J]. 中国实用口腔科杂志, 2014, 7(6): 324-328.
	Shen GF. Digital techniques and orthognathic surgery[J]. Chin J Pract Stomatol, 2014, 7(6): 324-328.
4	王旭东, 朱敏. 正颌外科学: 原则、策略和实践[M]. 上海: 上海科学技术出版社, 2021: 84.
	Wang XD, Zhu M. Orthognathic surgery: principles, planning and practice[M]. Shanghai: Shanghai Scientific and Technical Publishers, 2021: 84.
5	李彪, 姜腾飞, 沈舜尧, 等. 3D打印个体化钛板在正颌手术中的应用及其准确性评价[J]. 中国口腔颌面外科杂志, 2016, 14(5): 419-424.
	Li B, Jiang TF, Shen SR, et al. Accuracy of 3D printing individual titanium plates for maxillary repositioning in orthognathic surgery[J]. Chin J Oral Maxillofac Surg, 2016, 14(5): 419-424.
6	魏弘朴, 余婧爽, 姜腾飞, 等. 三维打印钛合金颅颌面接骨板的生物力学性能分析[J]. 中国口腔颌面外科杂志, 2017, 15(6): 503-507.
	Wei HP, Yu JS, Jiang TF, et al. Biomechanical analysis of three-dimensional printing titanium alloy cranioma-xillofacial bone plate[J]. Chin J Oral Maxillofac Surg, 2017, 15(6): 503-507.
7	王旭东, Lee PK, 沈国芳, 等. 计算机辅助模型外科设计及虚拟板的临床应用[J]. 中国口腔颌面外科杂志, 2008, 6(6): 403-409.
	Wang XD, Lee PK, Shen GF, et al. A preliminary application of the imaging-based splint for orthognathic surgery[J]. Chin J Oral Maxillofac Surg, 2008, 6(6): 403-409.
8	代杰文, 王璧霞, 魏弘朴, 等. 数字化正颌外科流程及临床效果回顾性分析[J]. 上海交通大学学报(医学版), 2016, 36(9): 1333-1340.
	Dai JW, Wang BX, Wei HP, et al. Retrospective analysis of the procedure of digital orthognathic surgery and its clinical effects[J]. J Shanghai Jiaotong Univ (Med Sci), 2016, 36(9): 1333-1340.
9	张天嘉, 徐昱婷, 沈国芳, 等. 国际正颌外科发展回顾与展望[J]. 中国口腔颌面外科杂志, 2018, 16(6): 547-552.
	Zhang TJ, Xu YT, Shen GF, et al. Development of orthognathic surgery: an overview[J]. Chin J Oral Maxillofac Surg, 2018, 16(6): 547-552.
10	Broadbent BH. A new X-ray technique and its application to orthodontics[J]. Angel Orthod, 1931, 1: 45-66.
11	Bench RW. The visual treatment objective: orthodontic’s most effective treatment planning tool[J]. Proc Found Orthod Res, 1971, 1971: 165-194.
12	沈舜尧, 陈天天, 卢陈佩, 等. 虚拟设计与传统模型外科矫治偏突颌畸形的对比研究[J]. 中华口腔医学杂志, 2016, 51(11): 651-655.
	Shen SR, Chen TT, Lu CP, et al. Comparison between computer aided simulation and dental model orthognathic surgery for the treatment of patients with mandibular excess and facial asymmetries[J]. Chin J Stomatol, 2016, 51(11): 651-655.
13	Dai J, Hu G, Wang X, et al. CBCT combining with plaster models: application in virtual three-dimensional su-bapical segmental osteotomy to obtain more precise occlusal splint[J]. J Craniofac Surg, 2012, 23(6): 1759-1762.
14	Liu Z, Shen S, Xia JJ, et al. A modified method of proximal segment alignment after sagittal split ramus osteotomy for patients with mandibular asymmetry[J]. J Oral Maxillofac Surg, 2015, 73(12): 2399-2407.
15	Hsu SP, Gateno J, Bell RB, et al. Accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery: a prospective multicenter study[J]. J Oral Maxillofac Surg, 2013, 71(1): 128-142.
16	蔡鸣, 杨育生, 王旭东, 等. 三维打印精准手术导板与传统咬合导板在偏颌畸形治疗中的对比研究[J]. 中华整形外科杂志, 2018, 34(6): 417-421.
	Cai M, Yang YS, Wang XD, et al. The comparison of 3D printing surgical guide and traditional occlusal splint in the treatment with facial asymmetry cases[J]. Chin J Plast Surg, 2018, 34(6): 417-421.
17	Li B, Zhang L, Sun H, et al. A novel method of compu-ter aided orthognathic surgery using individual CAD/CAM templates: a combination of osteotomy and repositioning guides[J]. Br J Oral Maxillofac Surg, 2013, 51(8): E239-E244.
18	Li B, Shen S, Jiang W, et al. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: a preliminary study[J]. Int J Oral Maxillofac Surg, 2017, 46(10): 1298-1305.
19	Gander T, Bredell M, Eliades T, et al. Splintless orthognathic surgery: a novel technique using patient-specific implants (PSI)[J]. J Craniomaxillofac Surg, 2015, 43(3): 319-322.
20	Mazzoni S, Bianchi A, Schiariti G, et al. Computer-ai-ded design and computer-aided manufacturing cutting guides and customized titanium plates are useful in upper maxilla waferless repositioning[J]. J Oral Maxillofac Surg, 2015, 73(4): 701-707.
21	Suojanen J, Leikola J, Stoor P. The use of patient-speci-fic implants in orthognathic surgery: a series of 32 ma-xillary osteotomy patients[J]. J Craniomaxillofac Surg, 2016, 44(12): 1913-1916.
22	Li B, Wei H, Jiang T, et al. Randomized clinical trial of the accuracy of patient-specific implants versus CAD/CAM splints in orthognathic surgery[J]. Plast Reconstr Surg, 2021, 148(5): 1101-1110.
23	沈国芳, 于洪波, 张诗雷, 等. 计算机辅助导航系统在颌面部陈旧性骨折治疗中的应用[J]. 中国口腔颌面外科杂志, 2009, 7(3): 195-199.
	Shen GF, Yu HB, Zhang SL, et al. Application of computer assisted navigation in the treatment of maxillofacial malunioned fractures[J]. Chin J Oral Maxillofac Surg, 2009, 7(3): 195-199.
24	Badiali G, Roncari A, Bianchi A, et al. Navigation in orthognathic surgery: 3D accuracy[J]. Facial Plast Surg, 2015, 31(5): 463-473.
25	Li B, Zhang L, Sun H, Shen SGF, et al. A new method of surgical navigation for orthognathic surgery: optical tracking guided free-hand repositioning of the maxillomandibular complex[J]. J Craniofac Surg, 2014, 25(2): 406-411.
26	顾勤浩, 何乐人. 虚拟现实和增强现实技术在整形外科中应用的研究进展[J]. 中华整形外科杂志, 2019, 35(11): 1138-1145.
	Gu QH, He LR. Applications of virtual reality and augmented reality technology in plastic surgery[J]. Chin J Plast Surg, 2019, 35(11): 1138-1145.
27	张楚茜, 张诗雷. 增强现实技术的研究进展及临床应用概述[J]. 组织工程与重建外科杂志, 2018, 14(1): 17-20.
	Zhang CX, Zhang SL. Research progress and clinical application of augmented reality technique[J]. J Tissue Eng Reconstr Surg, 2018, 14(1): 17-20.
28	Badiali G, Ferrari V, Cutolo F, et al. Augmented reality as an aid in maxillofacial surgery: validation of a wea-rable system allowing maxillary repositioning[J]. J Craniomaxillofac Surg, 2014, 42(8): 1970-1976.
29	Mischkowski RA, Zinser MJ, Kübler A, et al. Application of an augmented reality tool for maxillary positio-ning in orthognathic surgery—A feasibility study[J]. J Craniomaxillofac Surg, 2006, 34(8): 478-483.
30	Kim SH, Lee SJ, Choi MH, et al. Quantitative augmen-ted reality-assisted free-hand orthognathic surgery using electromagnetic tracking and skin-attached dynamic re-ference[J]. J Craniomaxillofac Surg, 2020, 31(8): 2175-2181.
31	林承重, 张勇, 董韶, 等. 基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究[J]. 华西口腔医学杂志, 2022, 40(6): 676-684.
	Lin CZ, Zhang Y, Dong S, et al. Application of mixed reality-based surgical navigation system in craniomaxillofacial trauma bone reconstruction[J]. West China J Stomatol, 2022, 40(6): 676-684.
32	朱建华, 郭传瑸. 手术机器人系统在颅颌面外科中的应用及发展[J]. 华西口腔医学杂志, 2016, 34(5): 534-538.
	Zhu JH, Guo CB. Application and development of surgical robot systems in craniomaxillofacial surgery[J]. West China J Stomatol, 2016, 34(5): 534-538.
33	回文宇, 吴锦阳, 黄建华, 等. 机器人辅助颏成形术行截骨操作的精度评价实验研究[J]. 上海交通大学学报(医学版), 2022, 42(9): 1347-1352.
	Hui WY, Wu JY, Huang JH, et al. Experimental study on the accuracy evaluation of robot-assisted osteotomy of genioplasty[J]. J Shanghai Jiaotong Univ (Med Sci), 2022, 42(9): 1347-1352.
34	Wu J, Hui W, Chen S, et al. Error analysis of robot-assisted orthognathic surgery[J]. J Craniofac Surg, 2020, 31(8): 2324-2328.
35	Zhang W, Alghannam F, Zhu Y, et al. Effects of drilling technology on mini-implant primary stability: a comparison of the mechanical drilling and femtosecond laser ablation[J]. Front Phys, 2022, 9: 766644.
36	Han JJ, Woo SY, Yi WJ, et al. Robot-assisted maxillary positioning in orthognathic surgery: a feasibility and accuracy evaluation[J]. J Clin Med, 2021, 10(12): 2596.
37	Holzinger D, Ureel M, Wilken T, et al. First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies[J]. J Craniomaxillofac Surg, 2021, 49(7): 531-537.
38	Lin L, Xu C, Shi Y, et al. Preliminary clinical experience of robot-assisted surgery in treatment with genioplasty[J]. Sci Rep, 2021, 11(1): 6365.
39	Li B, Shen SG, Yu H, et al. A new design of CAD/CAM surgical template system for two-piece narrowing genioplasty[J]. Int J Oral Maxillofac Surg, 2016, 45(5): 560-566.
40	Li B, Wei H, Zeng F, et al. Application of a novel three-dimensional printing genioplasty template system and its clinical validation: a control study[J]. Sci Rep, 2017, 7(1): 5431.
41	李彪, 魏弘朴, 姜腾飞, 等. 三维打印颏成形术导板的临床应用及准确性初探[J]. 中华口腔医学杂志, 2016, 51(11): 646-650.
	Li B, Wei HP, Jiang TF, et al. Clinical application and accuracy of the genioplasty surgical templates system for osseous genioplasty[J]. Chin J Stomatol, 2016, 51(11): 646-650.
42	Li B, Wang S, Wei H, et al. The use of patient-specific implants in genioplasty and its clinical accuracy: a preliminary study[J]. Int J Oral Maxillofac Surg, 2020, 49(4): 461-465.
43	Liu K, Xu Y, Abdelrehem A, et al. Application of virtual planning for three-dimensional guided maxillofacial reconstruction of Pruzansky-Kaban Ⅲ hemifacial microsomia using custom made fixation plate[J]. J Craniofac Surg, 2021, 32(3): 896-901.
44	Qi L, Cao N, Ge W, et al. A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma[J]. Orphanet J Rare Dis, 2021, 16(1): 59.
45	何东明, 毛丽霞, 刘凯, 等. 精准牙-骨移动的手术先行正颌正畸联合治疗—数字医学时代的理念与尝试[J]. 口腔医学, 2022, 42(1): 20-28.
	He DM, Mao LX, Liu K, et al. Combined orthodontic and orthognathic treatment by using “accurate tooth-bo-ne movement surgery first approach”, ideas and trials in digital medicine era[J]. Stomatology, 2022, 42(1): 20-28.

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