Achievability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery

Sci Rep. 2017 Aug 24;7(1):9314. doi: 10.1038/s41598-017-09488-4.

Abstract

The present study was aimed to investigate the effects of sequencing a two-component surgical procedure for correcting malpositioned jaws (bimaxillary osteotomies); specifically, surgical repositioning of the upper jaw-maxilla, and the lower jaw-mandible. Within a population of 116 patients requiring bimaxillary osteotomies, the investigators analyzed whether there were statistically significant differences in postoperative outcome as measured by concordance with a preoperative digital 3D virtual treatment plan. In one group of subjects (n = 58), the maxillary surgical procedure preceded the mandibular surgery. In the second group (n = 58), the mandibular procedure preceded the maxillary surgical procedure. A semi-automated analysis tool (OrthoGnathicAnalyser) was applied to assess the concordance of the postoperative maxillary and mandibular position with the cone beam CT-based 3D virtual treatment planning in an effort to minimize observer variability. The results demonstrated that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. In selected circumstances, such as a planned counterclockwise rotation of both jaws, the mandible-first sequence resulted in more predictable displacements of the jaws.

MeSH terms

  • Adolescent
  • Adult
  • Cone-Beam Computed Tomography
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Mandible / surgery*
  • Maxilla / surgery*
  • Middle Aged
  • Orthognathic Surgical Procedures / methods*
  • Osteotomy / methods*
  • Treatment Outcome
  • Young Adult