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Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A Preliminary Assessment of Real-Time Cephalometry as Part of the Computer-Assisted Planning and Execution Workstation for Craniomaxillofacial Surgery

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Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A Preliminary Assessment of Real-Time Cephalometry as Part of the Computer-Assisted Planning and Execution Workstation for Craniomaxillofacial Surgery

Auteurs : Ryan J. Murphy ; Ehsan Basafa ; Sepehr Hashemi ; Gerald T. Grant ; Peter Liacouras ; Srinivas M. Susarla ; Yoshito Otake ; Gabriel Santiago ; Mehran Armand ; Chad R. Gordon

Source :

RBID : PMC:4758939

Abstract

Background

The aesthetic and functional outcomes surrounding Le Fort–based, face-jaw-teeth transplantation have been suboptimal, often leading to posttransplant class II/III skeletal profiles, palatal defects, and “hybrid malocclusion.” Therefore, a novel technology—real-time cephalometry—was developed to provide the surgical team instantaneous, intraoperative knowledge of three-dimensional dentoskeletal parameters.

Methods

Mock face-jaw-teeth transplantation operations were performed on plastic and cadaveric human donor/recipient pairs (n = 2). Preoperatively, cephalometric landmarks were identified on donor/recipient skeletons using segmented computed tomographic scans. The computer-assisted planning and execution workstation tracked the position of the donor face-jaw-teeth segment in real time during the placement/inset onto recipient, reporting pertinent hybrid cephalometric parameters from any movement of donor tissue. The intraoperative data measured through real-time cephalometry were compared to posttransplant measurements for accuracy assessment. In addition, posttransplant cephalometric relationships were compared to planned outcomes to determine face-jaw-teeth transplantation success.

Results

Compared with postoperative data, the real-time cephalometry–calculated intraoperative measurement errors were 1.37 ± 1.11 mm and 0.45 ± 0.28 degrees for the plastic skull and 2.99 ± 2.24 mm and 2.63 ± 1.33 degrees for the human cadaver experiments. These results were comparable to the posttransplant relations to planned outcome (human cadaver experiment, 1.39 ± 1.81 mm and 2.18 ± 1.88 degrees; plastic skull experiment, 1.06 ± 0.63 mm and 0.53 ± 0.39 degrees).

Conclusion

Based on this preliminary testing, real-time cephalometry may be a valuable adjunct for adjusting and measuring “hybrid occlusion” in face-jaw-teeth transplantation and other orthognathic surgical procedures.


Url:
DOI: 10.1097/PRS.0000000000001455
PubMed: 26218382
PubMed Central: 4758939


Affiliations:


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<title>Background</title>
<p id="P1">The aesthetic and functional outcomes surrounding Le Fort–based, face-jaw-teeth transplantation have been suboptimal, often leading to posttransplant class II/III skeletal profiles, palatal defects, and “hybrid malocclusion.” Therefore, a novel technology—real-time cephalometry—was developed to provide the surgical team instantaneous, intraoperative knowledge of three-dimensional dentoskeletal parameters.</p>
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<title>Results</title>
<p id="P3">Compared with postoperative data, the real-time cephalometry–calculated intraoperative measurement errors were 1.37 ± 1.11 mm and 0.45 ± 0.28 degrees for the plastic skull and 2.99 ± 2.24 mm and 2.63 ± 1.33 degrees for the human cadaver experiments. These results were comparable to the posttransplant relations to planned outcome (human cadaver experiment, 1.39 ± 1.81 mm and 2.18 ± 1.88 degrees; plastic skull experiment, 1.06 ± 0.63 mm and 0.53 ± 0.39 degrees).</p>
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