The accuracy of two-dimensional planning for routine orthognathic surgery

Two-dimensional cephalometric planning software should be helpful for prediction of hard tissue outcome after bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy, but transferring two-dimensional data to three-dimensions (including mock operation and surgery) may result in errors. The objective of this retrospective study was to analyze deviations between predicted results and postoperative outcome using cephalometric analyses, and to evaluate this procedure for daily use. Fifty-four subjects (mean (SD) age 26 (8) years) had a BSSRO (n = 21) alone or in combination with Le Fort I osteotomy (n = 33). Predictions were made for each case by cephalometric planning software and mock operations done with study models. Postoperative cephalograms were obtained after 14 days and compared with predicted cephalograms for sagittal (SNA, SNB, ANB,) and vertical (ArMeGo, ML–NSL, NL–NSL) measurements. Mean (SD) differences for all measurements varied between 1.3° (1.1°) and 2.2° (1.6°) for BSSRO; and between 1.1° (1.3°) and 2.2° (1.6°) for bimaxillary osteotomy. There were no significant differences between measurements or operations, indicating that the predictions were accurate. A difference of up to 8.5° could be measured in a single case. Cephalometric prediction therefore remains an accurate tool for planning, particularly maxillary rearrangement in the vertical and sagittal dimension for routine operations. If greater shifts in the transversal dimension are necessary, exact planning should be adapted with three-dimensional planning devices to avoid significant differences.