Virtual Planning for Orthognathic Surgery in Cleft Lip and Palate Patients
A Comprehensive Literature Review
Keywords:
3D modeling, cleft lip and palate, digital workflow, functional outcomes, interdisciplinary collaboration, Le Fort osteotomies, maxillofacial surgery, orthognathic surgery, patient satisfaction, speech rehabilitation, symmetry correction, virtual surgical planningAbstract
Cleft lip and palate deformities pose significant challenges in maxillofacial surgery, requiring meticulous planning to address both functional and aesthetic concerns. Virtual Surgical Planning (VSP) has revolutionized the field of orthognathic surgery by integrating advanced imaging, 3D modeling, and computer-aided design/manufacturing (CAD/CAM) technologies. This comprehensive literature review explores the transformative role of VSP in managing cleft orthognathic cases, focusing on its impact on surgical precision, functional rehabilitation, and aesthetic outcomes.
The review synthesizes findings from recent studies to highlight advancements in digital workflows, interdisciplinary collaboration, and patient-centered care. Key applications of VSP include multi-stage surgical planning, enhanced speech clarity, improved masticatory efficiency, and airway management. Moreover, VSP facilitates aesthetic refinements such as facial symmetry correction and midline alignment, contributing to higher patient satisfaction. Challenges, including cost barriers, technical constraints, and training disparities, are also addressed.
Emerging innovations, such as augmented reality integration, machine learning algorithms, and personalized surgical guides, promise to further enhance the precision and efficacy of VSP-guided interventions. By improving long-term functional stability, aesthetic durability, and quality of life, VSP has become an indispensable tool in the holistic management of cleft lip and palate patients requiring orthognathic surgery.
References
Arce, K. (2020). Computer-Guided Oral and Maxillofacial Surgery: Opportunities to Transform
Patient Care. In Atlas of the Oral and Maxillofacial Surgery Clinics (Vol. 28, Issue 2). Elsevier
BV. https://doi.org/10.1016/j.cxom.2020.06.003
Arce, K., Morris, J. M., Alexander, A. E., & Ettinger, K. S. (2020). Developing a Point-of-Care
Manufacturing Program for Craniomaxillofacial Surgery [Review of Developing a Point-of-Care
Manufacturing Program for Craniomaxillofacial Surgery]. Atlas of the Oral and Maxillofacial
Surgery Clinics, 28(2), 165. Elsevier BV. https://doi.org/10.1016/j.cxom.2020.06.002
Brown, J., & Mcdowell, F. (2023). SURGICAL REPAIR OF CLEFT LIPS.
http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.1948.01240010761006
Carretero, J. L. C., & Cuéllar, C. N. (2022). New Technologies for Personalized Medicine in
Head and Neck Oncologic and Reconstructive Surgery. In Journal of Clinical Medicine (Vol. 11,
Issue 15, p. 4261). Multidisciplinary Digital Publishing Institute.
https://doi.org/10.3390/jcm11154261
Chim, H., Wetjen, N. M., & Mardini, S. (2014). Virtual Surgical Planning in Craniofacial
Surgery. In Seminars in Plastic Surgery (Vol. 28, Issue 3, p. 150). Thieme Medical Publishers
(Germany). https://doi.org/10.1055/s-0034-1384811
Cleft and Craniofacial Surgery. (2023). https://joms.org/retrieve/pii/S0278239117304871
Davey, M. G., McInerney, N., Barry, T., Hussey, A., & Potter, S. (2019). Virtual Surgical
Planning Computer-aided Design-guided Osteocutaneous Fibular Free Flap for Craniofacial
Reconstruction: A Novel Surgical Approach [Review of Virtual Surgical Planning
Computer-aided Design-guided Osteocutaneous Fibular Free Flap for Craniofacial
Reconstruction: A Novel Surgical Approach]. Cureus. Cureus, Inc.
https://doi.org/10.7759/cureus.6256
Dhima, M., Salinas, T., & Rieck, K. L. (2013). Virtual Surgical Planning for Treatment of Severe
Mandibular Retrognathia With Collapsed Occlusion Using Contemporary Surgical and
Prosthodontic Protocols. In Journal of Oral and Maxillofacial Surgery (Vol. 71, Issue 11, p.
. Elsevier BV. https://doi.org/10.1016/j.joms.2013.06.216
Faber, J., Miranda, L. A., Faber, C., Valim, P., Bicalho, L. S., & Milki-Neto, J. (2018).
Surgery-first orthognathic surgery with computer assisted three-dimensional planning [Review of
Surgery-first orthognathic surgery with computer assisted three-dimensional planning]. Seminars
in Orthodontics, 24(4), 430. Elsevier BV. https://doi.org/10.1053/j.sodo.2018.10.007
Farrell, B. B., Franco, P., & Tucker, M. R. (2014). Virtual Surgical Planning in Orthognathic
Surgery [Review of Virtual Surgical Planning in Orthognathic Surgery]. Oral and Maxillofacial
Surgery Clinics of North America, 26(4), 459. Elsevier BV.
https://doi.org/10.1016/j.coms.2014.08.011
Gallerano, G., Ruoppolo, G., & Silvestri, A. (2012). Myofunctional and speech rehabilitation
after orthodontic-surgical treatment of dento-maxillofacial dysgnathia. In Progress in
Orthodontics (Vol. 13, Issue 1, p. 57). Springer Nature. https://doi.org/10.1016/j.pio.2011.08.002
Gibson, T. L., & Shetye, P. R. (2017). Collaborative care and the modern craniofacial treatment
team [Review of Collaborative care and the modern craniofacial treatment team]. Seminars in
Orthodontics, 23(3), 255. Elsevier BV. https://doi.org/10.1053/j.sodo.2017.05.001
Han, H., Zhang, C., Zhu, L., Singh, P., Hsung, T.-C., Leung, Y. Y., Komura, T., Wang, W., & Gu,
M. (2024). Facial Surgery Preview Based on the Orthognathic Treatment Prediction. In arXiv
(Cornell University). Cornell University. https://doi.org/10.48550/arxiv.2412.11045
Harbour, P. W., Charipova, K., Dang, D., Moores, L. E., & Baker, S. B. (2020). Novel Use of a
Custom Fixation Plate in Pediatric Fibrous Dysplasia. In Plastic & Reconstructive Surgery
Global Open (Vol. 8, Issue 11). Wolters Kluwer. https://doi.org/10.1097/gox.0000000000003262
Hopper, R. A., Tse, R., Smartt, J. M., Swanson, J. W., & Kinter, S. (2014). Cleft Palate Repair
and Velopharyngeal Dysfunction. In Plastic & Reconstructive Surgery (Vol. 133, Issue 6, p. 852).
Lippincott Williams & Wilkins. https://doi.org/10.1097/prs.0000000000000184
Hossameldin, R. H., & McCain, J. P. (2014). The Efficacy of Computer-Based Pre Operative
Virtual Planning of Orthognathic Surgery and Fabrication of Intra-operative Cutting and
Positioning Guides with Pre Bending of Fixation Maxillary Plates. In Journal of Oral and
Maxillofacial Surgery (Vol. 72, Issue 9). Elsevier BV. https://doi.org/10.1016/j.joms.2014.06.080
Huang, Y.-H., Seelaus, R., Zhao, L., Patel, P. K., & Cohen, M. (2016). Virtual surgical planning
and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case
report. In International Medical Case Reports Journal (p. 341). Dove Medical Press.
https://doi.org/10.2147/imcrj.s118139
Hyman, C. H., & Buchanan, E. P. (2013). LeFort I Osteotomy. In Seminars in Plastic Surgery
(Vol. 27, Issue 3, p. 149). Thieme Medical Publishers (Germany).
https://doi.org/10.1055/s-0033-1357112
Inouye, J. M., Pelland, C. M., Lin, K. Y., Borowitz, K. C., & Blemker, S. S. (2015). A
Computational Model of Velopharyngeal Closure for Simulating Cleft Palate Repair. In Journal
of Craniofacial Surgery (Vol. 26, Issue 3, p. 658). Lippincott Williams & Wilkins.
https://doi.org/10.1097/scs.0000000000001441
James, J. N., Costello, B. J., & Ruiz, R. L. (2014). Management of Cleft Lip and Palate and Cleft
Orthognathic Considerations [Review of Management of Cleft Lip and Palate and Cleft
Orthognathic Considerations]. Oral and Maxillofacial Surgery Clinics of North America, 26(4),
Elsevier BV. https://doi.org/10.1016/j.coms.2014.08.007
Jayaram, R., & Huppa, C. (2012). Surgical Correction of Cleft Lip and Palate [Review of
Surgical Correction of Cleft Lip and Palate]. Frontiers of Oral Physiology/Frontiers of Oral
Biology, 101. Karger Publishers. https://doi.org/10.1159/000337664
Khan, M. J., Tageldin, T., Farooqi, M. W., Khamash, O., Shahid, U., Abdul-Rahman, M. E.-F.,
Elarref, M., & Hassan, J. (2020). Principles of Anesthesia and Airway Management in Head and
Neck Surgery. In IntechOpen eBooks. IntechOpen. https://doi.org/10.5772/intechopen.95029
Kim, Y. J., Kelley, B. P., Nasser, J. S., & Chung, K. C. (2019). Implementing Precision Medicine
and Artificial Intelligence in Plastic Surgery: Concepts and Future Prospects. In Plastic &
Reconstructive Surgery Global Open (Vol. 7, Issue 3). Wolters Kluwer.
https://doi.org/10.1097/gox.0000000000002113
Knoops, P. G. M., Papaioannou, A., Borghi, A., Breakey, R. W. F., Wilson, A. T., Jeelani, O.,
Zafeiriou, S., Steinbacher, D. M., Padwa, B. L., Dunaway, D., & Schievano, S. (2019). A
machine learning framework for automated diagnosis and computer-assisted planning in plastic
and reconstructive surgery. In Scientific Reports (Vol. 9, Issue 1). Nature Portfolio.
https://doi.org/10.1038/s41598-019-49506-1
Napoli, J. A., & Vallino, L. D. (2018). Achieving Excellence in Cleft Care: In Delaware Journal
of Public Health (Vol. 4, Issue 1, p. 30). https://doi.org/10.32481/djph.2018.01.008
Naran, S., Steinbacher, D. M., & Taylor, J. A. (2018). Current Concepts in Orthognathic Surgery
[Review of Current Concepts in Orthognathic Surgery]. Plastic & Reconstructive Surgery,
(6), 925. Lippincott Williams & Wilkins. https://doi.org/10.1097/prs.0000000000004438
Neel, E. A. A., Chrzanowski, W., Salih, V., Kim, H., & Knowles, J. C. (2014). Tissue engineering
in dentistry [Review of Tissue engineering in dentistry]. Journal of Dentistry, 42(8), 915. Elsevier
BV. https://doi.org/10.1016/j.jdent.2014.05.008
Oh, J.-H. (2018). Recent advances in the reconstruction of cranio-maxillofacial defects using
computer-aided design/computer-aided manufacturing [Review of Recent advances in the
reconstruction of cranio-maxillofacial defects using computer-aided design/computer-aided
manufacturing]. Maxillofacial Plastic and Reconstructive Surgery, 40(1). Springer
Science+Business Media. https://doi.org/10.1186/s40902-018-0141-9
Sayadi, L. R., Hamdan, U. S., Zhangli, Q., & Vyas, R. M. (2022). Harnessing the Power of
Artificial Intelligence to Teach Cleft Lip Surgery. In Plastic & Reconstructive Surgery Global
Open (Vol. 10, Issue 7). Wolters Kluwer. https://doi.org/10.1097/gox.0000000000004451
Scolozzi, P., & Herzog, G. (2016). Computer-Assisted Virtual Planning for Surgical Guide
Manufacturing and Internal Distractor Adaptation in the Management of Midface Hypoplasia in
Cleft Patients. In The Cleft Palate-Craniofacial Journal (Vol. 54, Issue 4, p. 457). SAGE
Publishing. https://doi.org/10.1597/15-208
Shenaq, D., & Matros, E. (2018). Virtual planning and navigational technology in reconstructive
surgery [Review of Virtual planning and navigational technology in reconstructive surgery].
Journal of Surgical Oncology, 118(5), 845. Wiley. https://doi.org/10.1002/jso.25255
Steinbacher, D. M. (2015). Three-Dimensional Analysis and Surgical Planning in
Craniomaxillofacial Surgery. In Journal of Oral and Maxillofacial Surgery (Vol. 73, Issue 12).
Elsevier BV. https://doi.org/10.1016/j.joms.2015.04.038
Stranix, J. T., Stern, C. S., Rensberger, M., Ganly, I., Boyle, J. O., Allen, R. J., Disa, J. J.,
Mehrara, B. J., Garfein, E. S., & Matros, E. (2019). A Virtual Surgical Planning Algorithm for
Delayed Maxillomandibular Reconstruction. In Plastic & Reconstructive Surgery (Vol. 143, Issue
, p. 1197). Lippincott Williams & Wilkins. https://doi.org/10.1097/prs.0000000000005452
Sweeny, L., Fuson, A., & Curry, J. (2021). Current trends in midface reconstruction and use of
virtual surgical planning. In Plastic and Aesthetic Research. Medknow.
https://doi.org/10.20517/2347-9264.2020.228
Vella, J. B., & Tatum, S. A. (2019). Risk factors for velopharyngeal dysfunction following
orthognathic surgery in the cleft population [Review of Risk factors for velopharyngeal
dysfunction following orthognathic surgery in the cleft population]. Current Opinion in
Otolaryngology & Head & Neck Surgery, 27(4), 317. Lippincott Williams & Wilkins.
https://doi.org/10.1097/moo.0000000000000553
Wu, J., Hui, W., Huang, J., Luan, N., Lin, Y., Zhang, Y., & Zhang, S. (2022). The Feasibility of
Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique.
In Journal of Clinical Medicine (Vol. 11, Issue 22, p. 6807). Multidisciplinary Digital Publishing
Institute. https://doi.org/10.3390/jcm11226807
Zhao, L., Patel, P. K., & Cohen, M. (2012). Application of Virtual Surgical Planning with
Computer Assisted Design and Manufacturing Technology to Cranio-Maxillofacial Surgery. In
Archives of Plastic Surgery (Vol. 39, Issue 4, p. 309). Thieme Medical Publishers (Germany).
https://doi.org/10.5999/aps.2012.39.4.309
Zreaqat, M., Hassan, R., & Hanoun, A. (2017). Cleft Lip and Palate Management from Birth to
Adulthood: An Overview. In InTech eBooks. https://doi.org/10.5772/intechopen.68448
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