Comparison of feasibility, workflow, and costs of two virtual surgical planning systems for orthognathic surgery in patients with cleft lip and palate

Introduction : Patients with cleft lip and palate (CLP) present complex skeletal discrepancies which require orthognathic surgery (OS) for functional and aesthetic rehabilitation. In these cases, virtual surgical planning (VSP) is essential. Yet software-related factors such as efficacy, time requirements, and cost can influence treatment accessibility and accuracy. Considering the unique anatomical challenges of CLP, an optimized virtual workflow is essential to improve surgical predictability and reduce intraoperative risks. Objective : This study aims to evaluate the feasibility of two VSP software programs, comparing their efficacy, time requirements, and costs in a standardized OS workflow for CLP patients. Materials and Methods : Forty-five cone beam computed tomography (CBCT) scans of nonsyndromic patients with CLP who had undergone bimaxillary surgery (Le Fort I and bilateral sagittal split osteotomy) with or without genioplasty between 2013 and 2023 were analyzed. VSP was performed using NemoStudio and OrtogOnBlender (OOB), evaluating feasibility, processing time (from STL file import to surgical guide fabrication), and associated costs, including software acquisition. Results : A statistically significant difference (p<0.05) was found in software processing time: NemoStudio (8 min 22 s ± 2 min) was faster than OOB (24 min 17 s ± 3 min). Although NemoStudio required fewer steps to complete planning, it presented more interruptions (“bugs”) than OOB. Analysis revealed that NemoStudio costs approximately $8,000.00, including annual STL file export fees, while OOB is free, with extra costs limited to an optional training course. Conclusion : Both software programs proved viable for patients with anteroposterior discrepancies up to 10 mm. While NemoStudio demonstrated advantages in time efficiency and workflow simplicity, its high cost may restrict usage. In contrast, OOB, despite requiring longer processing time, offers a cost-effective alternative. The choice of software should align with case needs, especially for larger advancements requiring high accuracy due to anatomical complexity, such as extension and cleft type.