Tridimensional analysis of the maxillary sinus volume after orthognathic surgery using artificial intelligence

Abstract

Introduction: Skeletal dentofacial deformities of the maxilla and mandible in young patients can be treated with facial orthopedics and growth modulation; however, adult patients may require a surgical procedure to correct facial structures. The Le Fort I maxillary osteotomy is the most studied corrective surgical procedure and is commonly used for dentofacial deformities involving the maxilla. The Le Fort I osteotomy presents a variability of movements, as both maxillary advancement and setback, as well as superior or inferior repositioning, can involve almost all surrounding tissues, including the maxillary sinus, airways, upper lip, and nasal tissues. The maxillary sinuses develop from early childhood until about 25 years of age, remaining constant after this maturation unless a surgical procedure interferes with normal development. The maxillary sinuses are important for respiration, controlling speech resonance, and reducing the impact of facial trauma, as they help dissipate traumatic forces. Surgical movement of the maxilla can affect sinus morphology, triggering inflammatory and morphological changes. No studies have focused on high-resolution three-dimensional evaluation with the aid of artificial intelligence for volumetric assessment. This study aims to contribute to the understanding of morphological changes that may also impact patient clinical outcomes. The use of artificial intelligence should be studied to validate its application in enhancing usability in facial surgery procedures.

Objectives: To evaluate the morphological and volumetric changes of the maxillary sinus after orthognathic surgery. To determine which maxillary movement has the greatest impact on the volume of the maxillary sinus after orthognathic surgery.

Methodology: Ten patients sought treatment for bimaxillary orthognathic surgery. All patients underwent computed tomography at the same institute, using the same parameters and equipment. From this point, virtual surgical planning was conducted by a single trained professional. The surgery proceeded as usual, without postoperative complications. All patients maintained close follow-up, returning to orthodontic treatment after twenty-one days. Six months postoperatively, the volume of the maxillary sinus was re-evaluated tomographically, using automatic segmentation performed by the NEMOFAB software (NEMOTEC, Spain), excluding human influence.

Results: The patients were evaluated six months after the surgical procedure, with the gender of the patients being well divided, consisting of 6 women and 4 men. Five patients presented type 2 deformity, while another five presented type 3 deformity. For the type 2 patients, who mostly underwent superior repositioning of the maxilla with counterclockwise movement of the occlusal plane, the maxillary sinus showed an average reduction of 3.4% (± 8.1%). Patients with type 3 skeletal deformities, undergoing treatment that involved maxillary advancement and correction of the occlusal plane, showed an average increase of 18.4% (± 10.1%) after six months.
Conclusion: The volume of the maxillary sinus increases significantly in patients seeking treatment for type 3 skeletal deformities, while for type 2 patients, there was maintenance of volume with a slight reduction.