UVA Clinic Face Architects virtual surgical planning protocol in orthognathic surgery: a practical method for outpatient surgery

Abstract

We describe an alternative workup protocol for surgical planning of orthognathic surgery in an office-based concept using a detailed data collection and presurgical work-up that includes a systematic calibration, specific facial markers, precise clinical photography, and the digital transfer of the occlusal data. We also share our office-based orthognathic surgery experience of 60 cases using this protocol. The clinical protocol consists of a cone-beam computed tomography (CBCT) scan of the patient, scan of stone models and physically transferred to service centre with a subsequent fusion of the two datasets. This technique eliminates the need for an additional dental model scan. This information is merged with skeletal components of the CBCT providing appropriate elements for surgical planning and fabrication of an intermediate splint by computer-aided design/computer-aided manufacturing technology. This technique forces us to perform a mandible-first sequence. The alignment of the fiducial markers and an appropriate calibration of the images endorse a better surgical planning and surgical prediction. This protocol has allowed us to perform more complex cases with more aggressive movements and ambitious osteotomies. We can correct the yaw orientation of the proximal and distal segments anticipating the segments interferences. This protocol provides great operative insight allowing us to improve our planning and our intraoperative efficiency. In 60 consecutive triple jaw cases our surgical mean time has been of 210 min, a mean blood loss of 250 mL. UVA Clinic Face Architects Orthognathic protocol supports us to accomplished a very safe, efficient, and cost-effective outpatient orthognathic surgery.