Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery

Mauricio Barreda Hale; Jorge Lolas; Emilio Moreno; Daniel Pino D.; Camila Arrué; Javier Beytía Erazo

doi:10.20986/recom.2020.1108/2019

Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery

Título traducido de la contribución: Comparación clínica de las referencias anatómicas externas para posicionamiento maxilar en cirugía ortognática

Mauricio Barreda Hale^*
, Jorge Lolas
, Emilio Moreno
, Daniel Pino D.
, Camila Arrué
, Javier Beytía Erazo

^*Autor correspondiente de este trabajo

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

Resumen

Introducción: El uso de puntos de referencia externos (ERP) como el pin nasal (NP) y el canto medial del ojo (EMC) proporciona puntos de referencia estables y reproducibles para el reposicionamiento maxilar. Los ERP son ampliamente utilizados por su practicidad para lograr el resultado estético deseado en cirugía ortognática (OS).
Objetivos: El propósito de este estudio es comparar los ERP (NP y EMC), para definir cuál es el más preciso, y también definir sus limitaciones, en la fase intraoperatoria para el reposicionamiento vertical del maxilar.
Pacientes y métodos: Realizamos un estudio retrospectivo en 26 pacientes que se sometieron a OS desde diciembre de 2015 hasta agosto de 2018. Antes de la osteotomía de Le Fort I, se realizaron las mediciones verticales. Se consideró el ERP más preciso el que obtuvo la menor diferencia promedio entre la medición vertical de la planificación prequirúrgica y la obtenida en el periodo intraoperatorio.
Resultados: El movimiento vertical planeado fue un promedio de -1,73 mm ± 1,97 SD, con el mayor movimiento de impactación maxilar de -6 mm y el mayor descenso maxilar de 2 mm. La diferencia entre el movimiento vertical planificado y las medidas obtenidas de cambio vertical para NP tuvo un promedio de 0,05 mm ± 0,51 DE (IC 95 %, -0,15 - 0,26), y la diferencia entre el movimiento vertical planificado y las medidas obtenidas para EMC tuvo un promedio de 1,23 mm ± 1,29 DE (IC 95 %, 0,71 - 1,75), con una diferencia estadísticamente significativa (p = 0,0001) entre ellos de -1,18 mm ± 1,23 (IC 95 %, -1,67 - -0,68).
Conclusiones: El uso del NP como ERP proporciona mayor precisión y previsibilidad del movimiento en el reposicionamiento vertical del complejo maxilomandibular, en comparación con el uso de EMC. Ambas técnicas se pueden utilizar como complemento, teniendo en cuenta el efecto de la triangulación.

Título traducido de la contribución	Comparación clínica de las referencias anatómicas externas para posicionamiento maxilar en cirugía ortognática
Idioma original	Inglés
Páginas (desde-hasta)	158-164
Número de páginas	7
Publicación	Revista Espanola de Cirugia Oral y Maxilofacial
Volumen	42
N.º	4
DOI	https://doi.org/10.20986/recom.2020.1108/2019
Estado	Publicada - 2020

Palabras clave

Asimetría facial
osteotomía de Le Fort
osteotomía maxilar
canthus media
pin nasal
cirugía ortognática

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10.20986/recom.2020.1108/2019Licencia: CC BY-NC-ND

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@article{efa80bc75261430f830d1d811ff82382,

title = "Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery",

abstract = "Introduction: The use of external reference points (ERP) like the nasal pin (NP) and eye{\textquoteright}s medial canthus (EMC) provides a stable and reproductible landmarks for maxillary repositioning. ERP are widely used, for its practicality to achieve the desired aesthetic result in orthognathic surgery (OS). Objectives: The purpose of this study is to compare the ERPs: NP and EMC, to define which is the most accurate, and also define its limitations, in the intraoperative phase for vertical repositioning of the maxilla. Patients and methods: We performed a retrospective study on 26 patients who underwent OS from December 2015 to August 2018. Previous to the Le Fort I osteotomy, the vertical measurements were made. The most accurate ERP was considered to be the one that obtained the least average difference between the vertical measurement of the pre-surgical planning and that obtained in the intraoperative period. Results: The planned vertical movement was an average of -1.73 mm ± 1.97 SD, with the largest maxillary impaction movement of -6 mm and the largest maxillary descent of 2 mm. The difference between planned vertical movement and obtained measurements of vertical change for NP had an average 0.05 mm ± 0.51 SD (95 \% CI, -0.15 - 0.26), and the difference between planned vertical movement and obtained measurements for EMC had an average 1.23 mm ± 1.29 SD (95 \% CI, 0.71 - 1.75), with a statistically significant difference (p = 0.0001) between them of -1.18 mm± 1.23 (95 \% CI, -1.67 - -0.68). Conclusions: The use of the NP as an ERP provides greater precision and predictability of movement in the vertical repositioning of the maxillomandibular-complex, compared to the use of EMC. Both techniques can be used as a complement, being aware of the effect of triangulation.",

keywords = "Facial asymmetry, Le Fort osteotomy, Maxillary osteotomy, Medial canthus, Nasal pin, Orthognathic surgery, Asimetr{\'i}a facial, osteotom{\'i}a de Le Fort, osteotom{\'i}a maxilar, canthus media, pin nasal, cirug{\'i}a ortogn{\'a}tica",

author = "\{Barreda Hale\}, Mauricio and Jorge Lolas and Emilio Moreno and \{Pino D.\}, Daniel and Camila Arru{\'e} and \{Beyt{\'i}a Erazo\}, Javier",

note = "{\textcopyright} 2020 SECOM.",

year = "2020",

doi = "10.20986/recom.2020.1108/2019",

language = "English",

volume = "42",

pages = "158--164",

journal = "Revista Espanola de Cirugia Oral y Maxilofacial",

issn = "1130-0558",

publisher = "Ediciones Ergon SA",

number = "4",

}

TY - JOUR

T1 - Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery

AU - Barreda Hale, Mauricio

AU - Lolas, Jorge

AU - Moreno, Emilio

AU - Pino D., Daniel

AU - Arrué, Camila

AU - Beytía Erazo, Javier

PY - 2020

Y1 - 2020

N2 - Introduction: The use of external reference points (ERP) like the nasal pin (NP) and eye’s medial canthus (EMC) provides a stable and reproductible landmarks for maxillary repositioning. ERP are widely used, for its practicality to achieve the desired aesthetic result in orthognathic surgery (OS). Objectives: The purpose of this study is to compare the ERPs: NP and EMC, to define which is the most accurate, and also define its limitations, in the intraoperative phase for vertical repositioning of the maxilla. Patients and methods: We performed a retrospective study on 26 patients who underwent OS from December 2015 to August 2018. Previous to the Le Fort I osteotomy, the vertical measurements were made. The most accurate ERP was considered to be the one that obtained the least average difference between the vertical measurement of the pre-surgical planning and that obtained in the intraoperative period. Results: The planned vertical movement was an average of -1.73 mm ± 1.97 SD, with the largest maxillary impaction movement of -6 mm and the largest maxillary descent of 2 mm. The difference between planned vertical movement and obtained measurements of vertical change for NP had an average 0.05 mm ± 0.51 SD (95 % CI, -0.15 - 0.26), and the difference between planned vertical movement and obtained measurements for EMC had an average 1.23 mm ± 1.29 SD (95 % CI, 0.71 - 1.75), with a statistically significant difference (p = 0.0001) between them of -1.18 mm± 1.23 (95 % CI, -1.67 - -0.68). Conclusions: The use of the NP as an ERP provides greater precision and predictability of movement in the vertical repositioning of the maxillomandibular-complex, compared to the use of EMC. Both techniques can be used as a complement, being aware of the effect of triangulation.

AB - Introduction: The use of external reference points (ERP) like the nasal pin (NP) and eye’s medial canthus (EMC) provides a stable and reproductible landmarks for maxillary repositioning. ERP are widely used, for its practicality to achieve the desired aesthetic result in orthognathic surgery (OS). Objectives: The purpose of this study is to compare the ERPs: NP and EMC, to define which is the most accurate, and also define its limitations, in the intraoperative phase for vertical repositioning of the maxilla. Patients and methods: We performed a retrospective study on 26 patients who underwent OS from December 2015 to August 2018. Previous to the Le Fort I osteotomy, the vertical measurements were made. The most accurate ERP was considered to be the one that obtained the least average difference between the vertical measurement of the pre-surgical planning and that obtained in the intraoperative period. Results: The planned vertical movement was an average of -1.73 mm ± 1.97 SD, with the largest maxillary impaction movement of -6 mm and the largest maxillary descent of 2 mm. The difference between planned vertical movement and obtained measurements of vertical change for NP had an average 0.05 mm ± 0.51 SD (95 % CI, -0.15 - 0.26), and the difference between planned vertical movement and obtained measurements for EMC had an average 1.23 mm ± 1.29 SD (95 % CI, 0.71 - 1.75), with a statistically significant difference (p = 0.0001) between them of -1.18 mm± 1.23 (95 % CI, -1.67 - -0.68). Conclusions: The use of the NP as an ERP provides greater precision and predictability of movement in the vertical repositioning of the maxillomandibular-complex, compared to the use of EMC. Both techniques can be used as a complement, being aware of the effect of triangulation.

KW - Facial asymmetry

KW - Le Fort osteotomy

KW - Maxillary osteotomy

KW - Medial canthus

KW - Nasal pin

KW - Orthognathic surgery

KW - Asimetría facial

KW - osteotomía de Le Fort

KW - osteotomía maxilar

KW - canthus media

KW - pin nasal

KW - cirugía ortognática

U2 - 10.20986/recom.2020.1108/2019

DO - 10.20986/recom.2020.1108/2019

M3 - Article

SN - 1130-0558

VL - 42

SP - 158

EP - 164

JO - Revista Espanola de Cirugia Oral y Maxilofacial

JF - Revista Espanola de Cirugia Oral y Maxilofacial

IS - 4

ER -

Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery

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