Orthognathic Surgery Simulation Using Cadavers

Walker, Michael

Historically, clinical training in orthognathic surgery for oral surgery residents has been gained through performing surgery on actual patients in the operating room. On the job training for these specialized surgical techniques has the potential for leading to less than ideal outcomes. Recently surgical simulation techniques have been shown to benefit trainees. In 2010 Tucker, et al used virtual reality surgical simulation repetitively until reaching specific target criteria to significantly improve subsequent operating room performance of residents. In 2012, Kienle et al looked at the utility of using cadavers in orthognathic surgery training. OMFS residents participated in a cadaver course in orthognathics and then were surveyed regarding the training. Residents felt the cadaver lab was of benefit and improved their surgical understanding and performance with respect to orthognathic surgery.

The current study was designed to gather data regarding oral surgery residents experience with simulated orthognathic surgery training and expand the amount of information available about residents attitudes regarding the utility and benefit of receiving simulated training in orthognathic surgery. An online survey was emailed to all OMFS residents and interns who had an email listed in the AAOMS directory. A study protocol was developed and approved by the University of Pennsylvania IRB to investigate the perceived attitudes of participants in the survey. The questionnaire consisted of 8 demographic questions to assess participants experience in performing orthognathic surgery in the OR and to determine what types of orthognathic surgery training they have received outside of the OR. This was followed by a series of 10 statements about the use of cadavers in orthognathic surgery training that were each rated on a 10 point scale on level of agreement. All participants were invited to fill out the online survey after being presented an online informed consent. The survey accepted responses for up to one month.

Out of 791 residents and interns invited to participate, 180 (23%) accepted the informed consent and responded to the survey. Respondents were from all years of training in both 4and 6 year programs. Results were descriptively analyzed. Over half of respondents were from 6 year programs (54%) with the remainder from 4 year programs. 34% had performed more than 10 orthognathic cases in the role of junior surgeon. 26.5% of respondents had never operated as junior surgeon during an orthognathic case. 63.5% had never been involved in cadaver training for orthognathic surgery while 36.5% had at least once. 53.5% had been involved in some type of orthognathic training other than on cadavers, including computer simulation, model surgery, or saw bones. In general, the residents felt the cadaver lab was a realistic simulation of clinical orthognathic procedures (average 7.6/10), and that the cadaver training improved their clinical understanding of the procedures (average 8.5/10). The majority of those polled disagreed with the statement that similar or superior surgical knowledge could be attained on a computer simulation of orthognathic surgery as on cadavers (average 4.4/10). Most of those surveyed said they would recommend the training to all oral surgery residents (average 8.6/10).

In conclusion, residents who have experienced orthognathic surgery training in the cadaver lab felt that it was worthwhile and improved their clinical understanding of the performed procedures. Surgical simulation, specifically in the cadaver lab has the potential to be a promising and effective tool for training oral surgery residents in orthognathic surgery.

Sources:

1) Tucker, et al. Comparison of actual surgical outcomes and 3-dimensional surgical simulations. J Oral Maxillofac Surg 68:10, 2010

2) Kienle MP, Chou JC, Stanton DCS. Cadaver Training in the Education of Orthognathic Surgery. J Oral Maxillofac Surg 70:9, Supp 2, 2012.