Endoscopic-Assisted Mandibular Angle Revision Using Patient-Specific PEEK Implants: Surgical Accuracy and Aesthetic Outcomes in Over-Resected Mandibles.

Abstract

Background: Mandibular angle osteotomy (MAO) is a popular procedure to improve facial aesthetics, however, over-resection of the mandibular angle can lead to both functional and aesthetic challenges. Precision is essential in restoring these over-resected mandibles to achieve balanced outcomes. Polyetheretherketone (PEEK) implants offer biocompatibility, durability, and customization potential, making them valuable for achieving precise and predictable results. This study examines the efficacy of PEEK patient-specific implants (PSIs) in endoscopic-assisted mandibular angle revision (MAR) surgery, assessing improvements in surgical accuracy and aesthetic outcomes.

Methods: We retrospectively analyzed 24 patients (39 mandibles) who underwent MAR from January 2019 to December 2023. Surgical accuracy was measured by comparing planned and achieved PSI positions using root mean square error (RMSE) and maximum deviation (MaxD). Patient satisfaction was assessed using the FACE-Q questionnaire, administered preoperatively and at least six months postoperatively, with correlations drawn between implant fit accuracy and FACE-Q scores changes.

Results: The average RMSE ranged from 0.1166 to 0.3149 mm, with 96% of PSIs showing deviations under 0.3 mm. FACE-Q scores for lower facial appearance and psychological well-being improved significantly, form 42.50 ± 5.28 to 56.08 ± 4.58 and 61.50±4.31 to 70.58 ± 6.46, respectively. A strong negative correlation was observed between implant fit accuracy (RMSE, MaxD) and FACE-Q score improvements related to appearance.

Conclusions: Endoscopic-assisted MAR with PEEK PSIs offers precise correction and significant aesthetic improvements for patients with over-resected mandibles. This technique demonstrated high surgical accuracy and favorable patient-reported outcomes. Future studies on a larger scale are recommended to validate these findings.

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