Accuracy of Virtual Surgical Planning in Le Fort III Distraction Osteogenesis: A 3-Dimensional Evaluation of Planned and Achieved Outcomes

BACKGROUND: Syndromic hypoplasia of the midface can be addressed by Le Fort III osteotomy. Three-dimensional planning tools and cutting guides have the potential to facilitate the design of Le Fort III osteotomy and distraction vectors, anticipate potential challenges, and mitigate adverse events. This study aimed to evaluate the accuracy of 3D-printed cutting guides for Le Fort III osteotomies with external-frame distraction osteogenesis and to identify the challenges associated with the manufacturing of these cutting guides. METHODS: Virtual planning was implemented in the operating room using a 3D-printed supraorbital reference bar that incorporated puzzle-like connections for the planned osteotomy guides. This design has been discussed extensively. Various systems have been introduced to facilitate the transfer of distraction vectors and positioning of external midface distractors. The precision of the osteotomy cuts, placement of the frame, and distraction vector were verified using a standardized protocol comparing planned and postoperative imaging. RESULTS: The planning process and the subsequent transfer of virtual planning to the operating room were validated using five cases. The overall margin of error was ∼1.2 times the voxel size of the CT scan used for preoperative planning. CONCLUSIONS: Three-dimensional planning tools and cutting guides facilitate the design of Le Fort III osteotomy and the determination of the distraction vector. The implementation of a 3D-printed supraorbital reference bar ensures the precise transfer of the surgical plan to the operating room.