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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)350-362
Number of pages13
JournalPlastic and reconstructive surgery
Volume136
Issue number2
DOIs
StatePublished - Aug 31 2015

ASJC Scopus subject areas

  • Surgery

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