Clinician’s Corner: Virtual Surgical Planning for Cleft/Craniofacial Orthognathic Surgery

ACPAACPA News, Clinician's Corner, Research

Jason Portnof DMD, MD, FACS

Orthognathic Surgery is often performed in patients with a history of cleft palate or craniofacial conditions. The surgery is performed when the patient has completed facial skeletal growth, to correct residual dentofacial deformity and asymmetry. Surgery is planned in combination with orthodontic treatment, after leveling and alignment of the dental arches, and orthodontic preparation of the patient for surgery.

When performed in the cleft and craniofacial patient, orthognathic surgery often involves surgery in both maxillary and mandibular bones, and may include bone grafting, a genioplasty procedure and/or malar region augmentation, with a goal to correct form and function.

Traditional planning for orthognathic surgery involves careful clinical measurements, photographs, plain film radiographs (panoramic, lateral cephalometric, PA/AP cephalometric x-rays) and obtaining dental study models and bite registrations. Computerized cephalometric tracings and surgical predictions in many cases augment or replace traditional paper tracings and work-ups.

The incorporation of conebeam CT scans (CBCT) into the presurgical work-up has allowed for accurate treatment planning in 3 dimensions, virtual surgical planning (VSP) and the fabrication of patient specific hardware, presurgical identification and quantification of bone defects, all of which can reduce operative time under general anesthesia. The use of VSP and surgical study models can assist in patient education during the presurgical informed consent process.

Drawbacks of the technique involve the additional exposure to radiation and increased costs.

To those providers that are regularly performing cleft/craniofacial orthognathic surgery, I ask: are you incorporating this methodology into your practice? If so, are you using this technique for all patients, or only in select cases? What is your decision tree to make these clinical decisions?

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