Establishment and application of a digital workflow in the treatment of condylar osteochondroma and secondary dentofacial deformities using image-guided endoscopic navigation combined with orthognathic surgery

Abstract

Objective: To establish a digital workflow in the treatment of mandibular condylar osteochondroma with secondary dentofacial deformities using navigation and endoscope combined with orthognathic surgery. Methods: Thirty-six patients with unilateral condylar osteochondroma were analyzed retrospectively. Preoperative planning and simulation were carried out on the digital three-dimansional (3D) model in all patients. With the aid of image-guided endoscopic navigation, osteochondroma resection and condylectomy were accurately performed. Secondary dentofacial deformities were simultaneously corrected using orthognathic surgery. All patients were followed up regularly and received postoperative CT scans. The preoperative simulated model and the postoperative actual model were matched using ProPlan CMF 2.0 software. Four corresponding points were marked in the virtual and actual ostectomy plane, respectively. The intersections of mandibular sigmoid notch and posterior ramusrim with condylectomy plane were marked as the anterior point and the posterior point, respectively. The perpendicular bisector of the line from the anterior point to the posterior point was intersected with the lateral and medial margin of condylectomy plane to form the lateral point and the medial point, respectively. The straight-line distances between the corresponding points in the virtual and actual ostectomy plane were respectively measured to analyze the ostectomy discrepancy. Results: All of 36 patients obtained satisfactory clinical effects. Facial symmetry and morphology were greatly improved. Postoperative CT showed that condylar tumors were completely removed. The preoperative simulated model and the postoperative actual model were matched. The average discrepancy between the planned and actual surgical resection was minimal on the anterior points ([0.24 ± 0.17] mm) and the mean error was maximal on the posterior points ([3.86±1.03] mm). The patients showed no signs of tumor recurrence in the 6 to 12 months of follow-up. Conclusions: Endoscope-assisted and navigation-guided tumor resection and condylectomy combined with simultaneous orthognathic surgery has satisfactory clinical effects in the treatment of condylar osteochondroma and secondary dentofacial deformities. The digital management workflow reported in this paper provides us a valuable option for this potentially complicated procedure.