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

Jeroen Liebregts,Martien De Koning,Thomas Maal,Tong Xi,Frank Baan,Edwin Ongkosuwito,Stefaan Bergé

doi:10.1038/s41598-017-09488-4

Jeroen Liebregts, Martien De Koning + Show 5 more

Open Access

https://doi.org/10.1038/s41598-017-09488-4

Copy DOI

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.

Highlights

Over the last decades, the surgical approach used during bimaxillary surgery, either maxillary-first or mandibular-first sequence, has been a controversial topic in the field of orthognathic surgery
A limited number of studies have been conducted on the accuracy of sequence in bimaxillary osteotomies[1,2,3,4]
This is first 3D clinical cohort study, to our knowledge, which evaluates the influences of maxilla-first or mandible-first surgical sequence of bimaxillary osteotomies on the achievability of the 3D virtual treatment planning

Summary

Introduction

The surgical approach used during bimaxillary surgery, either maxillary-first or mandibular-first sequence, has been a controversial topic in the field of orthognathic surgery (corrective jaw surgery). Several recent publications have described encouraging results with the mandible first sequencing protocol[1,2,3], with Perez and Ellis demonstrating the benefit of this approach in patients with counterclockwise (CCW) mandibular rotation and downgrafting of the posterior maxilla[4]. Despite these recent reports, there is still limited clinical and scientific consensus on which surgical approach taken during corrective jaw surgery can provide the most predictable clinical result.

Objectives

Methods

Results

Conclusion