Three-Dimensional Repositioning of the Maxilla in Orthognathic Surgery Using Patient Specific Titanium Plates: A Case Series

Purpose Successful orthognathic surgery is fundamentally based on accurately carrying out the intended surgical plan intra-operatively. The purpose of this study was to evaluate the accuracy of bone-borne patient specific maxillary cutting guides and three-dimensional (3D) printed plates in repositioning the maxilla during bimaxillary orthognathic surgery. Materials and Methods This was a retrospective case series consisting of patients who had undergone a LeFort I osteotomy with a patient specific cutting guide and 3D printed plate as well as a bilateral sagittal split osteotomy (BSSO) and had 6-week post-operative CBCT studies. The primary outcome variable was the difference between the position of the post-operative maxilla and the virtually planned maxilla measured at ten landmarks in three dimensions. Other study variables included the pre-operative diagnosis and planned surgical movement at each landmark. Descriptive statistics were tabulated and bivariate analyses were performed. Results A total of 10 patients were included in this study. The mean age was 25.7 ± 8.1 years and there were 5 female patients. The median planned surgical movement was 0.350mm on the x-axis (right-left), 3.750mm on the y-axis (anterior-posterior), and 1.704mm on the z-axis (superior-inferior). The median absolute discrepancy between the post-operative position and the planned position on the x-axis, y-axis, and z-axis was 0.638mm, 0.798mm, and 0.481mm, respectively. There was no significant difference in the discrepancies between the x-axis and y-axis (P = 0.575), the x-axis and z-axis (P = 0.332), and the y-axis and z-axis (P = 0.114). Conclusions Utilizing a patient specific cutting guide and 3D printed plate when performing a LeFort I osteotomy allows for accurate three-dimensional positioning of the maxilla in accordance with the surgical plan.