Virtual Surgical Planning for Orthognathic Surgery

  • Vincent Carrao
  • Mohammad Tofigh
  • Alex M. Greenberg


Orthognathic surgery has become a sophisticated operative procedure for the correction of dentofacial deformities. Recent advances in virtual surgical planning (VSP) allow surgeons’ improved computer-assisted digital preoperative case preparation compared to traditional plaster cast analysis and model surgery with lateral cephalometric prediction tracings. VSP allows surgeons to directly visualize osteotomy cuts, actual positioning of segments, visualization of occlusion, and 3D soft tissue predictions. Precise measurements of segment movements and bone excision for osteotomies allows highly accurate presurgical planning that is superior to traditional model surgery. Rapid printing of surgical splints and cutting guides has proven to be more accurate than handmade splints based on plaster models. Optical scans of the patient’s dentition or dental tests can be merged with the CT data. Orthognathic surgery for single or double jaw can be planned with virtual intermediate and final splints visualized and then printed for clinical use. Genioplasty can also be planned using VSP with cutting and positioning guides. Studies have shown that VSP saves considerable time and cost to patients, surgeons, hospitals, and insurance companies. Distraction osteogenesis can also be planned using VSP with the creation of cutting and hardware positioning guides. VSP is utilized for the combined planning of total TMJ alloplastic replacement in coordination with orthognathic surgery. In this way separate service providers can integrate custom implant fabrication with osteotomy planning. VSP permits a team approach and improved communication through web-based treatment planning sessions. VSP aids patient education through the 3D images developed through treatment planning with visualization of the surgical plan and prediction.


Orthognathic Virtual Treatment Planning Rapid printing Osteotomies Splint Cutting Guide 


  1. 1.
    Greenberg AM, Prein J, editors. Craniomaxillofacial Reconstructive and Corrective Bone Surgery: Principles of Internal Fixation Using the AO/ASIF Technique. New York: Springer Verlag; 2002. p. 581–622Google Scholar
  2. 2.
    Ellis E III, Tharanon W, Gambrell K. Accuracy of face-bow transfer effect on surgical prediction and postsurgical result. J Oral Maxillofac Surg. 1998;50:562.CrossRefPubMedGoogle Scholar
  3. 3.
    Gribel B, Gribel M, Frazao D, McNamara J Jr, Manzi F. Accuracy and reliability of craniometric measurements on lateral cephalometry and 3D measurements on CBCT scans. Angle Orthod. 2011;81:26–35.CrossRefPubMedGoogle Scholar
  4. 4.
    Bell R. Computer planning and intraoperative navigation in orthognathic surgery. J Oral Maxillofac Surg. 2011;69:592–605.CrossRefPubMedGoogle Scholar
  5. 5.
    Barbenel J, Paul P, Khambay B, Walker F, Moos K, Ayoub A. Errors in orthognathic surgery planning: the effect of inaccurate study model orientation. Int J Oral Maxillofac Surg. 2010;39:1103–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Schramm A, Gellrich NC, Schmelzeisen R. Navigational surgery of the facial skeleton. Berlin: Springer; 2007.Google Scholar
  7. 7.
    Vannier M, Marsh J, Warren J. Three dimensional CT reconstruction images for craniofacial surgical planning and evaluation. Radiology. 1984;150:179.CrossRefPubMedGoogle Scholar
  8. 8.
    Altobelli D, Kikinis R, Mulliken F, et al. Computer-assisted three-dimensional planning in craniofacial surgery. Plast Reconstr Surg. 1993;92:576.CrossRefPubMedGoogle Scholar
  9. 9.
    Hohlweg-Majert B, Schon R, Schmelzeisen R, et al. Navigational maxillofacial surgery using virtual models. World J Surg. 2005;29:1530.CrossRefPubMedGoogle Scholar
  10. 10.
    Luebbers H, Messmer P, Obwegeser J, et al. Comparison of different registration methods for surgical navigation in craniomaxillofacial surgery. J Craniomaxillofac Surg. 2008;36:109.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Vincent Carrao
    • 1
  • Mohammad Tofigh
    • 2
  • Alex M. Greenberg
    • 3
  1. 1.Division of Oral and Maxillofacial SurgeryThe Mount Sinai Hospital, Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Private PractiveOral and Maxillofacial SurgeryNew YorkUSA
  3. 3.Division of Oral and Maxillofacial SurgeryColumbia University College of Dental MedicineNew YorkUSA

Personalised recommendations