Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning

Peng Yuan, Huaming Mai, Jianfu Li, Dennis Chun Yu Ho, Yingying Lai, Siting Liu, Daeseung Kim, Zixiang Xiong, David M. Alfi, John F. Teichgraeber, Jaime Gateno, James J. Xia

Research output: Contribution to journalReview articlepeer-review

46 Citations (Scopus)


Purpose: There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. Methods: The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. Result: When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. Conclusion: We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.

Original languageEnglish
Pages (from-to)2129-2143
Number of pages15
JournalInternational journal of computer assisted radiology and surgery
Issue number12
Publication statusPublished - Dec 2017
Externally publishedYes


  • 3D cephalometric analysis
  • Composite skull model
  • Computed tomography
  • Computer-aided surgical simulation
  • Neutral head posture
  • Orthognathic surgery
  • Streamlined surgical splint design
  • Virtual osteotomy
  • Virtual surgical planning

ASJC Scopus subject areas

  • Surgery
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging
  • Computer Vision and Pattern Recognition
  • Computer Science Applications
  • Health Informatics
  • Computer Graphics and Computer-Aided Design


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