3D virtual surgical planning in patients with bilateral cleft lip and palate undergoing premaxilla osteotomy combined with secondary alveolar bone grafting: a retrospective accuracy analysis

This retrospective study evaluates the surgical accuracy of 3D virtual planning and the use of computer-aided design/computer-aided manufacturing splints in premaxillary osteotomy combined with secondary alveolar bone grafting. The study included all consecutive patients with bilateral cleft lip and palate undergoing a premaxillary osteotomy with secondary alveolar bone grafting treated by the Cleft Team North (the Netherlands) between 2016 and 2023. 3D virtual surgical planning was based on cone beam computed tomography scans and intraoral scans or plaster models. Surgical accuracy was assessed by comparing the planned and postoperative images of the premaxilla through three linear and three angular measurements. Eleven patients were included (mean age: 9.8 years). The mean Euclidean distance between the planned and postoperative outcomes was 1.57 ± 0.79 mm. Linear measurements showed mean differences of 0.74 ± 0.76 mm medio-laterally, 0.65 ± 0.53 mm caudo-cranially, and 0.89 ± 0.70 mm anteroposteriorly. Angular differences were 6.66 ± 5.12° for pitch, 5.09 ± 5.14° for yaw, and 4.61 ± 5.05° for roll. The intra-observer variability was 0.85 ± 0.58 mm and the intraclass correlation coefficient 0.99. High surgical accuracy can be achieved using 3D virtual surgical planning and computer-aided design/computer-aided manufacturing splints in premaxillary osteotomy combined with secondary alveolar bone grafting.