Application of three-dimensional printed plates in Le Fort III osteotomy

Abstract

Background: Patient-specific surgical plates using three-dimensional (3D) printing technology has been used in head and neck reconstruction and orthognathic surgery. It has been reported that the use of 3D printing in orthognathic surgery can facilitate precise translation of the treatment plan, reduce surgical time, provide optimal functional and aesthetic results, and increase patient safety. Objectives: To report a case of simultaneous Le Fort III / Le Fort I osteotomy using three-dimensional printed surgical guides and fixation plates, illustrating the workflow and evaluate the treatment outcome. Methods: A 21-year old Chinese female presenting with zygomaticomaxillary hypoplasia and mandibular hyperplasia was scheduled for simultaneous Le Fort III/ Le Fort I osteotomy and bilateral sagittal osteotomy. Computer planning based on cone beam CT (CBCT) and laser scanning of the dentition was performed using ProPlan CMF. Surgical guides and fixation plates for Le Fort III and Le Fort I osteotomy were designed using Mimics, and subsequently 3D printed. Postoperatively, CBCT was taken to evaluate the treatment outcome. Findings: Comparing the postoperative CBCT with the virtual surgical plan, the movement of the midface and the maxilla was achieved as planned. Both the surgeons and patient were satisfied with the treatment outcome. The major advantage of the use of 3D printed plates in Le Fort III osteotomy is that it facilitated proper orientation and fixation of the mobile midface which would have been difficult if conventional miniplates were used. Conclusion: 3D printed surgical templates and fixation plates are preferred in Le Fort III osteotomy and should be considered to use routinely.