Treatment of Dentofacial Deformities Secondary to Osteochondroma of the Mandibular Condyle Using Virtual Surgical Planning and 3-Dimensional Printed Surgical Templates

Abstract

Purpose: One-stage treatment for condylar osteochondroma and secondary facial deformities by resection and reconstruction of the mandibular condyle, orthognathic surgery, and mandibular contouring has been reported recently. This study investigated the clinical feasibility of treating osteochondroma of the mandibular condyle and secondary dento-maxillofacial deformities by virtual surgical planning and 3-dimensional (3D) printed surgical templates.

Materials and methods: A composite skull model with accurate dentition was obtained with data from spiral computed tomography (CT) and surface scanning of the dental arch. Virtual surgical simulation was performed using Dolphin Imaging 11.7 Premium and Mimics software after a comprehensive 3D diagnosis and surgery planning. Surgical templates were fabricated by 3D printing using data from virtual surgical simulation for guidance of excision of the mandibular condyle with osteochondroma, reconstruction of the mandibular condyle, mandibular contouring, and reconstruction of a normal occlusion. Le Fort I osteotomy of the upper jaw and genioplasty were performed when indicated. The linear difference between virtually simulated and postoperative skull models was evaluated.

Results: All surgeries were successfully simulated using virtual surgical planning, and the guiding templates were successfully applied for all patients. Successful reconstruction of condylar function, normal occlusion, and symmetry of the facial profile was achieved. Postoperative CT scans and quantitative analysis showed that virtual surgical plans provided acceptable accuracy in the operating room. The linear difference of the incisors and first molars was no more than 1.4 mm, and the greatest difference was found for the menton landmark, which was up to 2.4 mm.

Conclusions: Results from this study suggested that virtual surgical planning and guiding templates facilitated accurate diagnosis, treatment planning, accurate osteotomy, repositioning of bony segments, and contouring of the mandibular border in the treatment of condylar osteochondroma and secondary facial asymmetry.