Purpose: Mismatch between preoperative planning and surgical outcome in maxillofacial surgery relate to on-table replication of presurgical planning and predictive algorithm inaccuracy: software error was hereby decoupled from planning inaccuracy to assess a commercial software. The hypothesis was that soft tissue prediction error would be minimized if the surgical procedure was replicated precisely as planned and is independent of the extent of bone repositioning. Materials and Methods: Cone-beam computed tomography scans of 16 Le Fort I osteotomy patients were collected at Boston Children's Hospital. Preoperative and postoperative models of bone and soft tissue were constructed and the maxilla repositioning was replicated. Each model was subdivided into 6 regions: mouth, nose, eyes, and cheeks. Soft tissue prediction (performed using Proplan CMF-Materialise) for each patient was compared with the relative postoperative reconstruction and error was determined. P<0.05 was considered significant. Results: Le Fort I segment repositioning was replicated within 0.70±0.18 mm. The highest prediction error was found in the mouth (1.49±0.77 mm) followed by the cheeks (0.98±0.34 mm), nose (0.86±0.23 mm), and eyes (0.76±0.32). Prediction error on cheeks correlated significantly with mouth (r=0.63, P< 0.01) and nose (r=0.67, P< 0.01). Mouth prediction error correlated with total advancement (r=0.52, P=0.04). Conclusions: ProPlan CMF is a useful outcome prediction tool; however, accuracy decreases with the extent of maxillary advancement even when errors in surgical replication are minimized.
Bibliographical noteFunding Information:
The authors acknowledge Vasileios Tsirkos from Karolinska University Hospital for the technical assistance.
The work has been funded by Great Ormond Street Hospital for Children Charity (Grant no. 12SG15) as well as the NIHR Biomedical Research Centre Advanced Therapies for Structural Malformations and Tissue Damage pump-prime funding call (Grant no. 17DS18), the Great Ormond Street Hospital Charity Clinical Research Starter Grant (Grant no. 17DD46), the Engineering and Physical Sciences Research Council (EP/N02124X/1), and the European Research Council (ERC-2017-StG-757923). This report incorporates independent research from the National Institute for Health Research Biomedical Research Centre Funding Scheme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health.
Copyright © 2022 Mutaz B. Habal, MD. All rights reserved.