title: Presurgical planning and time efficiency in orthognathic surgery: the use of computer-assisted surgical simulation.
abstract: Orthognathic procedures require extensive preoperative planning to maintain high fidelity of fabricated splints to anticipated skeletal and soft tissue changes. The authors report their use of the computer-assisted surgical simulation modeling system in preoperative planning and splint fabrication and the significant reduction in their overall preoperative time. Upper and lower bite registrations were sequentially created on a single bite jig with fast-drying bis-acryl material, which was then mounted to a fiducial-based facebow for facial skeleton indexing. Indexing data were submitted, and occlusal splints were fashioned and returned to the senior surgeon. Between September 2010 and January 2011, 10 consecutive patients were enrolled. Surgical indications included six Le Fort I advancements and four combined Le Fort I/bilateral sagittal split osteotomy cases. Average time for bite registration was 10 minutes 16 seconds ± 1 minute 33 seconds, with an additional 8 minutes 6 seconds ± 4 minutes 45 seconds needed for modeling and virtual splint confirmation. Six patients required cephalometric tracings, for an additional 12 minutes 50 seconds ± 1 minute 10 seconds. Average total session time for all patients was 26 minutes 14 seconds ± 9 minutes 13 seconds. Computer-assisted surgical simulation markedly decreased the time for preoperative splint planning and fabrication time, and had a positive impact on reimbursement rates for orthognathic surgery, as calculated on a per-hourly basis. The improved accuracy generated may lead to decreased operative times and improved outcomes.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
authors.forename: Derek
authors.initials: D
authors.lastname: Masden
authors.forename: Cathalene A
authors.initials: CA
authors.lastname: Blake
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D003198:Computer Simulation; D017076:Computer-Aided Design; D005260:Female; D006801:Humans; D007574:Jaw Relation Record / Q000379:methods; D008297:Male; D017090:Occlusal Splints; D056948:Orthognathic Surgical Procedures; D019340:Osteotomy, Le Fort / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013996:Time and Motion Studies; D055815:Young Adult