Correlation of fixture placement and patient symptoms in orthognathic surgery: A retrospective analysis of post-surgical evaluations and comparisons of multiple surgery protocols

Abstract

<h3>Objective</h3> This project aimed to analyze the proximity of orthognathic surgical fixation to specific anatomical landmarks and to assess postoperative symptoms. <h3>Study Design</h3> The data consisted of an available pool of CT scans from the oral surgery department at the University of Texas Health at San Antonio from 2015 to 2020. We investigated the proximity of orthognathic fixation to the maxillary sinus, nerve, and tooth. The inclusion criteria were full volume CBCT or MDCT scans, age of 14-60 years, primary orthognathic surgery. The exclusion criteria were past surgery or augmentation, congenital syndromes, acquired abnormalities, pathological lesions, and inadequate image quality. Screening of an available patient pool resulted in 400 patient scans. The pilot data consisted of 50 patients. We gathered information about patients' symptoms from their charts. We viewed the scans on the Dell NVIDIA Quadro P1000 23" monitor with 1920 × 1200 desktop resolution, 8-bit depth, and standard dynamic range for the image analysis. We performed measurements from the fixation to the closest point of the nearest vital structure (tooth, nerve, or sinus) on the Invivo6 version 6.0 Anatomage software, using axial, coronal, and sagittal views with the ruler tool to perform these measurements. We divided the measurements into three groups based on their proximity to the vital structures: A=0 mm, B≤2mm, and C>2mm. Finally, we compared patients' complaints and complications relative to the proximity of the surgical fixation to the vital structures. <h3>Results</h3> The preliminary data suggested a significant difference in symptoms associated with fixation at less than 2 mm. <h3>Conclusion</h3> We expect to find an increase in postoperative symptoms with proximity to the above-mentioned landmarks, to be determined by the chi-squared test for statistical analysis. Support of the hypothesis could encourage an emphasis on creating preoperative analysis standards affecting the identification, evaluation, and marking of vital structures on the images during preoperative surgical planning. <b>Statement of Ethical Review</b> Ethical Review or exemption was not warranted for this study