Does Mandible-first Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures?

Kasper Stokbro, Jeroen Liebregts, Frank Baan, Bryan Bell, Thomas Maal, Torben Thygesen, Tong Xi

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Purpose: In bimaxillary procedures, it is important to know how the chosen sequence affects the surgical outcome. The purpose of this study was to explore whether the theoretical advantages of using the mandible-first procedure were supported by clinical data. Materials and Methods: The authors performed a retrospective investigation on a cohort compiled from 3 published retrospective studies. The sample was composed of patients treated at the Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands)from 2010 to 2014 and the Odense University Hospital (Odense, Denmark)from 2011 to 2015. The inclusion criterion was bimaxillary surgery without maxillary segmentation. The exclusion criterion was lack of a virtual surgical plan. The primary outcome variable was surgical accuracy, defined as the mean difference between the obtained outcome and the virtual surgical plan. The primary predictor variable was the comparison between mandible-first and maxilla-first sequencing. Secondary predictors were inferior maxillary repositioning and counterclockwise (CCW)rotation. The confounding variable was the virtually planned reposition. Results were analyzed by mixed-model regression encompassing all variables, followed by a detailed analysis of positive results using 2-sample t tests. Results: Overall, 145 patients were included for analysis (98 women; mean age, 28 years). Operating on the mandible first notably influenced maxillary positioning and placed the maxilla 1.5 mm posterior and with 1.4° of CCW rotation compared with virtual surgical planning. The interaction of surgical sequence with maxillary rotation showed similar surgical accuracy between maxilla-first surgery with clockwise rotation and mandible-first surgery with CCW rotation. Inferior maxillary repositioning resulted in the maxilla being placed 1.7 mm (maxilla-first sequence)and 2.0 mm (mandible-first sequence)posterior to the planned position. Conclusion: Surgical accuracy was considerably influenced by sequencing in bimaxillary procedures. It remains important to know how the chosen sequence affects the surgical outcome so that the virtual surgical plan can be adjusted accordingly.

OriginalsprogEngelsk
TidsskriftJournal of Oral and Maxillofacial Surgery
Vol/bind77
Udgave nummer9
Sider (fra-til)1882-1893
ISSN0278-2391
DOI
StatusUdgivet - 1. sep. 2019

Fingeraftryk

Maxilla
Confounding Factors (Epidemiology)
Denmark
Netherlands
Retrospective Studies

Citer dette

Stokbro, Kasper ; Liebregts, Jeroen ; Baan, Frank ; Bell, Bryan ; Maal, Thomas ; Thygesen, Torben ; Xi, Tong. / Does Mandible-first Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures?. I: Journal of Oral and Maxillofacial Surgery. 2019 ; Bind 77, Nr. 9. s. 1882-1893.
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abstract = "Purpose: In bimaxillary procedures, it is important to know how the chosen sequence affects the surgical outcome. The purpose of this study was to explore whether the theoretical advantages of using the mandible-first procedure were supported by clinical data. Materials and Methods: The authors performed a retrospective investigation on a cohort compiled from 3 published retrospective studies. The sample was composed of patients treated at the Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands)from 2010 to 2014 and the Odense University Hospital (Odense, Denmark)from 2011 to 2015. The inclusion criterion was bimaxillary surgery without maxillary segmentation. The exclusion criterion was lack of a virtual surgical plan. The primary outcome variable was surgical accuracy, defined as the mean difference between the obtained outcome and the virtual surgical plan. The primary predictor variable was the comparison between mandible-first and maxilla-first sequencing. Secondary predictors were inferior maxillary repositioning and counterclockwise (CCW)rotation. The confounding variable was the virtually planned reposition. Results were analyzed by mixed-model regression encompassing all variables, followed by a detailed analysis of positive results using 2-sample t tests. Results: Overall, 145 patients were included for analysis (98 women; mean age, 28 years). Operating on the mandible first notably influenced maxillary positioning and placed the maxilla 1.5 mm posterior and with 1.4° of CCW rotation compared with virtual surgical planning. The interaction of surgical sequence with maxillary rotation showed similar surgical accuracy between maxilla-first surgery with clockwise rotation and mandible-first surgery with CCW rotation. Inferior maxillary repositioning resulted in the maxilla being placed 1.7 mm (maxilla-first sequence)and 2.0 mm (mandible-first sequence)posterior to the planned position. Conclusion: Surgical accuracy was considerably influenced by sequencing in bimaxillary procedures. It remains important to know how the chosen sequence affects the surgical outcome so that the virtual surgical plan can be adjusted accordingly.",
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Does Mandible-first Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures? / Stokbro, Kasper; Liebregts, Jeroen; Baan, Frank; Bell, Bryan; Maal, Thomas; Thygesen, Torben; Xi, Tong.

I: Journal of Oral and Maxillofacial Surgery, Bind 77, Nr. 9, 01.09.2019, s. 1882-1893.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Does Mandible-first Sequencing Increase Maxillary Surgical Accuracy in Bimaxillary Procedures?

AU - Stokbro, Kasper

AU - Liebregts, Jeroen

AU - Baan, Frank

AU - Bell, Bryan

AU - Maal, Thomas

AU - Thygesen, Torben

AU - Xi, Tong

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Purpose: In bimaxillary procedures, it is important to know how the chosen sequence affects the surgical outcome. The purpose of this study was to explore whether the theoretical advantages of using the mandible-first procedure were supported by clinical data. Materials and Methods: The authors performed a retrospective investigation on a cohort compiled from 3 published retrospective studies. The sample was composed of patients treated at the Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands)from 2010 to 2014 and the Odense University Hospital (Odense, Denmark)from 2011 to 2015. The inclusion criterion was bimaxillary surgery without maxillary segmentation. The exclusion criterion was lack of a virtual surgical plan. The primary outcome variable was surgical accuracy, defined as the mean difference between the obtained outcome and the virtual surgical plan. The primary predictor variable was the comparison between mandible-first and maxilla-first sequencing. Secondary predictors were inferior maxillary repositioning and counterclockwise (CCW)rotation. The confounding variable was the virtually planned reposition. Results were analyzed by mixed-model regression encompassing all variables, followed by a detailed analysis of positive results using 2-sample t tests. Results: Overall, 145 patients were included for analysis (98 women; mean age, 28 years). Operating on the mandible first notably influenced maxillary positioning and placed the maxilla 1.5 mm posterior and with 1.4° of CCW rotation compared with virtual surgical planning. The interaction of surgical sequence with maxillary rotation showed similar surgical accuracy between maxilla-first surgery with clockwise rotation and mandible-first surgery with CCW rotation. Inferior maxillary repositioning resulted in the maxilla being placed 1.7 mm (maxilla-first sequence)and 2.0 mm (mandible-first sequence)posterior to the planned position. Conclusion: Surgical accuracy was considerably influenced by sequencing in bimaxillary procedures. It remains important to know how the chosen sequence affects the surgical outcome so that the virtual surgical plan can be adjusted accordingly.

AB - Purpose: In bimaxillary procedures, it is important to know how the chosen sequence affects the surgical outcome. The purpose of this study was to explore whether the theoretical advantages of using the mandible-first procedure were supported by clinical data. Materials and Methods: The authors performed a retrospective investigation on a cohort compiled from 3 published retrospective studies. The sample was composed of patients treated at the Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands)from 2010 to 2014 and the Odense University Hospital (Odense, Denmark)from 2011 to 2015. The inclusion criterion was bimaxillary surgery without maxillary segmentation. The exclusion criterion was lack of a virtual surgical plan. The primary outcome variable was surgical accuracy, defined as the mean difference between the obtained outcome and the virtual surgical plan. The primary predictor variable was the comparison between mandible-first and maxilla-first sequencing. Secondary predictors were inferior maxillary repositioning and counterclockwise (CCW)rotation. The confounding variable was the virtually planned reposition. Results were analyzed by mixed-model regression encompassing all variables, followed by a detailed analysis of positive results using 2-sample t tests. Results: Overall, 145 patients were included for analysis (98 women; mean age, 28 years). Operating on the mandible first notably influenced maxillary positioning and placed the maxilla 1.5 mm posterior and with 1.4° of CCW rotation compared with virtual surgical planning. The interaction of surgical sequence with maxillary rotation showed similar surgical accuracy between maxilla-first surgery with clockwise rotation and mandible-first surgery with CCW rotation. Inferior maxillary repositioning resulted in the maxilla being placed 1.7 mm (maxilla-first sequence)and 2.0 mm (mandible-first sequence)posterior to the planned position. Conclusion: Surgical accuracy was considerably influenced by sequencing in bimaxillary procedures. It remains important to know how the chosen sequence affects the surgical outcome so that the virtual surgical plan can be adjusted accordingly.

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DO - 10.1016/j.joms.2019.03.023

M3 - Journal article

C2 - 31034793

VL - 77

SP - 1882

EP - 1893

JO - Journal of Oral and Maxillofacial Surgery

JF - Journal of Oral and Maxillofacial Surgery

SN - 0278-2391

IS - 9

ER -