| Objective1. To confirm the diagnosis of deformity site and develop a personalized surgical plan by using Surgicase CMF software in mandibular asymmetry. Assess the postoperative effect of the surgery plan by using mirroring technology.2. Conduct soft tissue computer simulation and prediction by SurgiCase CMF software in mandibular asymmetry patients who just need single jaw surgery. Evaluate the prediction accuracy by three-dimensional overlapping and measurement.3. Simulate mandibular angle orthopedic surgery by SurgiCase software to complete the computer-aided design and evaluate the predictive accuracy. Methods1. Select 27 patients of mandibular asymmetry who just need single jaw surgery. Reconstruct three-dimensional bone model in Surgicase CMF software using CBCT data. Confirm the deformity site based on mirroring technology and three-dimensional measurement, and then simulate various surgical procedures to develop individualized surgical plan with the consultation with patients. Complete the surgery according to the design plan and assess the effect using mirroring technology.2. CBCT data of 27 patients with mandibular asymmetry were observed in CMF, and postoperative soft tissue physiognomies were predicted by simulating sagittal ramus osteotomy with or without genioplasty. The symmetry measurement parameters of soft tissue were selected and the horizontal, coronal and sagittal planes were established. Analyze the results of predict and postoperative soft tissues. The overlap compared color grading charts were observed.3. Perform virtual mandibular angle osteotomy on digital model. Then negotiate with patients, personalized surgical plan was formulated. Simultaneously, evaluation of forecast and real soft tissue looks by orthognathic experts. Results1. Mirroring processing and three-dimensional measurement results : Co-MS, AG-MS, AG-FH, Co-Ag are with no statistically significant, indicating the symmetry of bilateral ramus is acceptable. Ag-Me, Co-Me, Co-Ag-Me are with statistically significant means the mandibular body is obviously asymmetry. Ag-N with statistically significant means the mandibular plane is apparently inclined. B1-MS, Me-MS, Me-ANS-MS, AG-AG-MS with statistically significant, indicating the lower jaw and chin are obviously skew. The above results are match with mirroring image.2. Postoperative assessment: By computer-aided design, the facial symmetry is improved. The patients are satisfied with facial shape. Postoperative mirror image shows good facial symmetry which is consistency with the preoperative design plan.3. The measurement results of the accuracy: The difference of Ch-Ch-FH and Sn-UL-LL are statistically significant(P <0.01, P <0.05), namely the predict accuracy of the mouth angular tilt and vertical inclination between upper and lower lip is poor. Go’-MS, Go’-Pog ’ and Sn- Me’-MS with no statistically significant difference, indicating a higher predictive accuracy of the mandibular angle and chin.4. By observing the overlap compared color grading charts, the prediction accuracy is worse in deviate side of the cheek than the contralateral side.5. The software provides design of the mandibular angle osteotomy position and osteotomy angle. The operations of all patients are smooth. The deformity improved significantly without infection and other complications. The evaluation of same and very like in front view is 12.5%, in profile view is 7%.The predictive accuracy is low. Conclusions1. By using Surgicase CMF software can help the communication between doctors and patients and can help in accurately diagnose, designing treatment plan, simulating the treatment process, guiding surgical procedures and evaluating postoperative results. It has high value and feasibility in clinical application.2. The predictive accuracy of CMF for mandibular asymmetry is high, but it has a little declination,especially in the lip and cheek.It still needs some improvement.3. Simulation software is important for the formulation of personalized safety prominent mandibular angle surgical plan, the visual of surgery procedure and postoperative effect, but the accuracy of prediction needs to further improve. |
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