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O.357 3D planning of orthognathic surgery – a prospective study
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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
visualized with the 3D data sets. The influence of orthognathic surgery on facial soft tissue proportions was measured accuretaly with 3D image matching. Proportional changes in the region of the lower face and specifically the cheek and chin region were measured. Conclusion: Merging of the pre- and postoperative 3D data sets is a useful tool to analyse surgical outcome of bilateral sagittal split osteotomies and have the potential to provide substantial additional data concerning changes of the facial proportions, so enabling accurate surgical treatment planning and prediction of surgical outcome. O.356 3D comparison of swelling following orthognathic surgery R. Majeed, W. Kater, J. Piffk´o, U. Joos. Oral and Maxillofacial Surgery, Bad Homburg, Germany Aims: To evaluate the effect hilotherapy in comparison with cool compressive in post operative management of swelling following orthognathic surgery. The facial swelling was measured in terms of volume (ml). Methods: This is a randomised observer blind prospective pilot study, where 30 patients included in the study and divided in two groups: Group 1 patients were recieving cool compressives and Group 2 patients were recieving hilotherapy. All the patients were diagnosed to be skeletal and dental deformities and recieved preoperative orthodontics and bimaxillary orthognathic surgery. All the patients were evaluated for swelling, pain, neurological problem and the confortability and tabulated in scores for 2nd post operative, 4th postoperative and upto 6 mths post operatively. Results: The results obtained from the comparison between two groups. The patients recieved hilotherapy (Group 2) achieved a good result in terms of swelling reduction, pain, neurological problems and comfortability in comparison with Group 1 patients with cool compressives. Conclusions: Based on the results, the presented three dimensional scans provides a new diagnostic and treatment device. The results confirmed shown a new method to measure facial swelling following orthognathic surgery. To conclude hilotherapy is a essential tool in reducing the postoperative swelling and other complaints from the patients recieving orthognathic surgery. O.357 3D planning of orthognathic surgery – a prospective study G. Swennen1 , J. Van Hove1 , C. De Clercq1 , J. Abeloos1 , P. Lamoral1 , F. Lippens1 , N. Neyt1 , F. Schutyser1 . 3-D Facial Imaging Research Group Nijmegen–Bruges (3D-FIRG). 1 General Hospital St. Jan, Bruges, Belgium Objectives: The purpose of this prospective study was to evaluate the virtual “on-screen” planning time of an integrated threedimensional (3-D) virtual approach towards orthognathic surgery. Methods: A total of 50 orthognathic patients were included in this study. For all patients, timing of the following virtual planning steps was recorded: (1) virtual 3-D Bruges cephalometric hard and soft tissues analysis (VPS-1); (2) virtual 3-D soft tissue analysis (VPS-2); (3) virtual osteotomies (VPS-3) and virtual surgery (VPS-4). All virtual plannings were performed by the same staff-member twice. The following orthognathic procedures were planned: 24 BSSO’s, 8 BSSO and chin osteotomies, 8 trimaxillary and 10 bi-maxillary osteotomies. Results: VPS-1 was performed in a mean planning time of 11.46±0.23; VPS-2 in 3.46±0.18; VPS-3 in 05.38±0.33 and VPS-4 in 23.17±0.33. The results of this study showed that especially VPS-4 was still time-consuming due to occlusal definition. Conclusion: Although 3-D virtual planning of orthognathic surgery could be performed in an acceptable time-frame, improvements in software are still needed especially towards 3-D virtual occlusal definition.
Abstracts, EACMFS XIX Congress O.358 A normal smile after Le Fort I osteotomy: alar cinch & V-Y? M. Muradin1 , A. Rosenberg1 , P. Stoelinga3 , R. Koole1 . 1 Department of Oral & Maxillofacial Surgery, 2 Department of Special Dental Care, UMC Utrecht, 3 Department of Oral & Maxillofacial Surgery, Umc St Radboud Nijmegen & Umc Maastricht, The Netherlands One of the goals for orthognathic surgery should be to increase nasolabial mobility to the “normal range” as seen in nondysgnathic patients. Le Fort 1 osteotomies do have the tendency, however, to create unwanted side effects of the upper lip such as loss of vermillion show, flattening of the lip and downturning of commissures. An earlier report has shown that an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) does improve nasolabial mobility [1]. To test if the improvement meets the “normal range” of nasolabial mobility, a prospective study was set up including 32 patients, 17 with ACVY, 15 with simple closing sutures (SCS) and 18 nonoperated, Angle class I – volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used containing two pictures: soft tissue in repose and maximum closed mouth smile. The landmarks, alare, crista philtri and cheilion were analyzed. The test has a standard deviation of 0.9 mm [2]. Statistical analysis was done on intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p < 0.05). The results show significant differences in nasolabial mobility compared with the control-group for both groups preoperatively. Postoperative mobility improved in both groups, i.e. intra-group assessment, but significantly for ACVY only. Postoperative inter-group differences in mobility were small and just significant for SCS versus control-group. Conclusion: ACVY-closure has a small, but yet significant benefit in that the nasolabial mobility came into the “normal range”. References [1] Muradin et al JCMFS suppl 2006. [2] Muradin et al IJOMFS 2007. O.359 Accuracy in orthognathic surgical planning and prediction O. Donatsky, J. Bjoern-Joergensen, N.U. Hermund, H. Nielsen, M. Holmqvist-Larsen, P.H. Nerder. Rigshospitalet, Section Hilleroed Hospital, University of Copenhagen, Hilleroed, Denmark Objectives: The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary anterosuperior repositioning combined with mandibular set back using the computerized, cephalometric, orthognathic surgical planning system (TIOPS). Methods: Out of 100 prospectively and consecutively treated patients 52 patients manifested dentofacial deformities requiring bimaxillary orthognathic surgery with maxillary antero-superior repositioning combined with mandibular set back and were so included. Preoperative cephalograms were analyzed and treatment plans and prediction tracings produced by computerized surgical interactive simulation. The planned hard tissue positional changes were transferred to model surgery on a three-dimensional articulator system (SAM) and finally to surgery. Five to six weeks after surgery, the actually obtained hard and soft tissue profile changes were cephalometricly assessed. Results: From a mean point of view the accuracy of the planned and predicted hard and soft tissue outcome was relative high varying from 0.0 mm to 0.5 mm. At the cephalometric reference points where statistically significant inaccuracies were revealed, these inaccuracies were except for the predicted horizontal position of the lower lip relative small varying from 0.2 mm to
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
visualized with the 3D data sets. The influence of orthognathic surgery on facial soft tissue proportions was measured accuretaly with 3D image matching. Proportional changes in the region of the lower face and specifically the cheek and chin region were measured. Conclusion: Merging of the pre- and postoperative 3D data sets is a useful tool to analyse surgical outcome of bilateral sagittal split osteotomies and have the potential to provide substantial additional data concerning changes of the facial proportions, so enabling accurate surgical treatment planning and prediction of surgical outcome. O.356 3D comparison of swelling following orthognathic surgery R. Majeed, W. Kater, J. Piffk´o, U. Joos. Oral and Maxillofacial Surgery, Bad Homburg, Germany Aims: To evaluate the effect hilotherapy in comparison with cool compressive in post operative management of swelling following orthognathic surgery. The facial swelling was measured in terms of volume (ml). Methods: This is a randomised observer blind prospective pilot study, where 30 patients included in the study and divided in two groups: Group 1 patients were recieving cool compressives and Group 2 patients were recieving hilotherapy. All the patients were diagnosed to be skeletal and dental deformities and recieved preoperative orthodontics and bimaxillary orthognathic surgery. All the patients were evaluated for swelling, pain, neurological problem and the confortability and tabulated in scores for 2nd post operative, 4th postoperative and upto 6 mths post operatively. Results: The results obtained from the comparison between two groups. The patients recieved hilotherapy (Group 2) achieved a good result in terms of swelling reduction, pain, neurological problems and comfortability in comparison with Group 1 patients with cool compressives. Conclusions: Based on the results, the presented three dimensional scans provides a new diagnostic and treatment device. The results confirmed shown a new method to measure facial swelling following orthognathic surgery. To conclude hilotherapy is a essential tool in reducing the postoperative swelling and other complaints from the patients recieving orthognathic surgery. O.357 3D planning of orthognathic surgery – a prospective study G. Swennen1 , J. Van Hove1 , C. De Clercq1 , J. Abeloos1 , P. Lamoral1 , F. Lippens1 , N. Neyt1 , F. Schutyser1 . 3-D Facial Imaging Research Group Nijmegen–Bruges (3D-FIRG). 1 General Hospital St. Jan, Bruges, Belgium Objectives: The purpose of this prospective study was to evaluate the virtual “on-screen” planning time of an integrated threedimensional (3-D) virtual approach towards orthognathic surgery. Methods: A total of 50 orthognathic patients were included in this study. For all patients, timing of the following virtual planning steps was recorded: (1) virtual 3-D Bruges cephalometric hard and soft tissues analysis (VPS-1); (2) virtual 3-D soft tissue analysis (VPS-2); (3) virtual osteotomies (VPS-3) and virtual surgery (VPS-4). All virtual plannings were performed by the same staff-member twice. The following orthognathic procedures were planned: 24 BSSO’s, 8 BSSO and chin osteotomies, 8 trimaxillary and 10 bi-maxillary osteotomies. Results: VPS-1 was performed in a mean planning time of 11.46±0.23; VPS-2 in 3.46±0.18; VPS-3 in 05.38±0.33 and VPS-4 in 23.17±0.33. The results of this study showed that especially VPS-4 was still time-consuming due to occlusal definition. Conclusion: Although 3-D virtual planning of orthognathic surgery could be performed in an acceptable time-frame, improvements in software are still needed especially towards 3-D virtual occlusal definition.
Abstracts, EACMFS XIX Congress O.358 A normal smile after Le Fort I osteotomy: alar cinch & V-Y? M. Muradin1 , A. Rosenberg1 , P. Stoelinga3 , R. Koole1 . 1 Department of Oral & Maxillofacial Surgery, 2 Department of Special Dental Care, UMC Utrecht, 3 Department of Oral & Maxillofacial Surgery, Umc St Radboud Nijmegen & Umc Maastricht, The Netherlands One of the goals for orthognathic surgery should be to increase nasolabial mobility to the “normal range” as seen in nondysgnathic patients. Le Fort 1 osteotomies do have the tendency, however, to create unwanted side effects of the upper lip such as loss of vermillion show, flattening of the lip and downturning of commissures. An earlier report has shown that an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) does improve nasolabial mobility [1]. To test if the improvement meets the “normal range” of nasolabial mobility, a prospective study was set up including 32 patients, 17 with ACVY, 15 with simple closing sutures (SCS) and 18 nonoperated, Angle class I – volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used containing two pictures: soft tissue in repose and maximum closed mouth smile. The landmarks, alare, crista philtri and cheilion were analyzed. The test has a standard deviation of 0.9 mm [2]. Statistical analysis was done on intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p < 0.05). The results show significant differences in nasolabial mobility compared with the control-group for both groups preoperatively. Postoperative mobility improved in both groups, i.e. intra-group assessment, but significantly for ACVY only. Postoperative inter-group differences in mobility were small and just significant for SCS versus control-group. Conclusion: ACVY-closure has a small, but yet significant benefit in that the nasolabial mobility came into the “normal range”. References [1] Muradin et al JCMFS suppl 2006. [2] Muradin et al IJOMFS 2007. O.359 Accuracy in orthognathic surgical planning and prediction O. Donatsky, J. Bjoern-Joergensen, N.U. Hermund, H. Nielsen, M. Holmqvist-Larsen, P.H. Nerder. Rigshospitalet, Section Hilleroed Hospital, University of Copenhagen, Hilleroed, Denmark Objectives: The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary anterosuperior repositioning combined with mandibular set back using the computerized, cephalometric, orthognathic surgical planning system (TIOPS). Methods: Out of 100 prospectively and consecutively treated patients 52 patients manifested dentofacial deformities requiring bimaxillary orthognathic surgery with maxillary antero-superior repositioning combined with mandibular set back and were so included. Preoperative cephalograms were analyzed and treatment plans and prediction tracings produced by computerized surgical interactive simulation. The planned hard tissue positional changes were transferred to model surgery on a three-dimensional articulator system (SAM) and finally to surgery. Five to six weeks after surgery, the actually obtained hard and soft tissue profile changes were cephalometricly assessed. Results: From a mean point of view the accuracy of the planned and predicted hard and soft tissue outcome was relative high varying from 0.0 mm to 0.5 mm. At the cephalometric reference points where statistically significant inaccuracies were revealed, these inaccuracies were except for the predicted horizontal position of the lower lip relative small varying from 0.2 mm to