Simulation-Guided Navigation

Abstract

Because of the recent development of three-dimensional technology, computer software is increasingly being used for diagnosis, analysis, data documentation, and surgical planning for orthognathic surgery. Currently, the typical method to reposition jaws in the correct and planned location is based on the use of surgical splints, which have a quite high level of imprecision. The most important differences between planned and achieved maxillary movements are in the vertical and rotational positioning. Several methods have been described for intraoperative maxillary control, but none of these procedures is satisfactory. We present a new method to transfer individualized three-dimensional virtual planning of the patient using a navigation system in the operating room to improve reproducibility of the simulation. We enrolled 10 patients with dentofacial deformities from November 2008 to May 2009. All patients were studied and treated according to the following steps: cone-beam computed tomography data acquisition, virtual simulation of the surgical procedure, surgery with intraoperative navigation, and validation through reproducibility evaluation. We found 86.5% mean preoperative surgical plan reproducibility with the assistance of simulation-guided navigation compared with 80% mean reproducibility obtained in our previous group, in which no intraoperative navigation was performed. According to these results, we can assume that simulation-guided navigation would be a helpful procedure during orthognathic surgery to improve reproducibility of the preoperative virtual surgical planning.

Virtual Planning of a Complex Three-Part Bimaxillary Osteotomy

“…This process demonstrated reliability both for common clinical situations [ 1 ] and for the most difficult deformities [ 2 , 3 ]; however, 3D imaging new technologies ensure a number of advantages for the clinician. It is nowadays possible to create a precise “virtual patient” combining data from three-dimensional scan of the maxillofacial skeleton [ 4 – 10 ], 3D scan of the dental casts or intraoral scanning, and, when necessary, stereophotogrammetry [ 11 ]. Several scientific papers have described these new procedures for the surgical planning [ 12 – 21 ]; these modern technologies do not add any new data but make data easier to interpret allowing a deeper understanding of the problems and a very accurate simulation of the surgery.…”

Computer-assisted preoperative simulation for positioning and fixation of plate in 2-stage procedure combining maxillary advancement by distraction technique and mandibular setback surgery

“…The recent development of computerized three-dimensional (3D) computed tomography (CT) has simplified the process 3D planning by incorporating a computer-assisted virtual surgical procedure, which is carried out during the real-time surgery procedure. This 3D planning enables the surgeon to interact with the 3D images and facilitate the positioning of Maxilla required for the fixation of the plate [2] . The first application of 3-dimensional (3D) imaging for the placement of five maxillary marking screws and intermaxillary fixation of prefabricated occlusal splint using the TBNavis-CMFS navigation system (Multifunctional Surgical Navigation System, Shanghai, China) was performed on six adult goats.…”

A precisão da cirurgia ortognática com placas de titânio personalizadas: revisão sistemática

“…Other studies have evaluated surgical precision three-dimensionally (Mazzoni et al, 2010;Hernández-Alfaro and Guijarro-Martínez, 2013;Sun et al, 2013;Stokbro and Thygesen, 2018a). The stability of the titanium plates was acceptable both immediately and long term.…”

“…The search for precision surgical planning and controlled outcomes in orthognathic surgery has been a constant challenge since its inception in the 19th century (Kretschmer et al, 2009;Brunso et al, 2016). Several surgical techniques have been explored to achieve planned results prior to surgery (Mazzoni et al, 2010;Bai et al, 2012;Zinser et al, 2012Zinser et al, , 2013Kokuryo et al, 2014;Gander et al, 2015). The traditional technique, based on the use of an interocclusal splint, is to perform a model surgery based on two-dimensional (2D) cephalogram surgical planning and handmade interocclusal splints for bone repositioning during surgery.…”

“…State of the art planning and performing of orthognathic surgery is closely linked to computer assistance. Several techniques are used to increase surgical precision in relation to virtual planning, including surgical guided navigation (Mazzoni et al, 2010), CAD-CAM repositioning guides (Zinser et al, 2012), and more recently, customized titanium plates (Philippe, 2013a(Philippe, , 2013bGander et al, 2015;Mazzoni et al, 2015;Brunso et al, 2016Brunso et al, , 2017Heufelder et al, 2017;Li et al, 2017;Kim et al, 2019). Customized titanium plates are based on surgical guide-oriented osteotomies, capable of repositioning bone segments without an occlusal splint (Mazzoni et al, 2015;Brunso et al, 2016;Heufelder et al, 2017;Li et al, 2017).…”