Virtual Surgical Planning versus Model Orthognathic Surgery: Can Patients Tell the Difference?

Abstract

<h3>Purpose</h3> The purpose of this study was to determine if the method of orthognathic surgery planning used - virtual surgical planning (VSP) versus conventional model surgery - influenced patient-perceived post-operative satisfaction. We hypothesize that there is no significant difference in subjective outcomes reported by patients planned with VSP and patients planned with conventional model surgery for orthognathic surgery. <h3>Methods</h3> This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a ten-year period from 2009-2019. The authors crafted an eight-question survey that utilized a five-point Likert scale for self-assessment to gauge patient satisfaction and awareness regarding the subjective outcomes of their orthognathic surgery (Figure 1). Patients were asked to complete the survey via email or telephone call. The predictor variable was method of orthognathic surgery planning utilized (VSP or conventional model surgery), and the outcome variables were the patient responses to each individual survey question. The data was analyzed for both the conventional model surgery group and the VSP group by computing the means, standard deviations, medians, and modes for each of the eight questions. A two-tailed Mann-Whitney U test was utilized for comparing the two study groups for any statistically significant difference (p < 0.05) in responses for each of the eight survey questions. <h3>Results</h3> There were 1,046 patients initially identified with 644 potential subjects meeting the inclusion criteria. The eight-question survey was successfully administered to 173 of these 644 subjects. In all, total participants included 138 conventional model surgery participants and 35 VSP participants. Patients who had their orthognathic surgery planned with VSP, rated their satisfaction with both their postoperative appearance and occlusion similarly (4.60, SD 1.06 and 4.69, SD 0.96, respectively) to those patients who were planned with conventional model surgery (4.40, SD 1.06 and 4.47, SD 0.98, respectively). Additionally, patients from both the model surgery group (3.75, SD 1.33) and VSP group (3.77, SD 142) had similar neurosensory outcomes. There was no statistically significant difference in the patient satisfaction scores between the two groups, including cosmetic, neurosensory and occlusion results (p > 0.05). However, there was a statistically significant difference between the two groups' responses for the question that asked patients whether or not their surgeon utilized VSP for their respective surgeries (p = 0.0041). <h3>Conclusion</h3> We fail to reject the null hypothesis. This study demonstrates that the method of orthognathic surgery planning utilized (VSP vs conventional model surgery) does not significantly impact patient-perceived post-operative satisfaction regarding cosmetic, neurosensory, and occlusion outcomes. In addition, this study showed that patients planned with VSP were significantly more likely to correctly identify that their orthognathic surgery had been planned with VSP when compared to the conventional model surgery patients. VSP has proven to be an accurate, timesaving, and potentially cost-saving tool for surgeons, but the surgical planning method does not appear to have a significant impact on patient-perceived subjective outcomes following orthognathic surgery