Abstract:

The core of orthognathic surgery planning lies in the precise spatial positioning of the jawbones. Traditional cephalometric analysis methods are limited by complex reference indices, heavy reliance on clinical experience, and a focus on achieving an “average facial morphology.” Andrews’ six elements of orofacial harmony, which take indivi-dual facial soft tissue landmarks as references, provide a novel approach for personalized jawbone positioning. This work reviews the theoretical framework of Andrews’ six elements on the basis of previous research and clinical experience and proposes an exploratory reference workflow for orthognathic surgery planning using Andrews’ six elements. This workflow centers surgical design on the upper facial-axis-goal anterior limit line (UFA-GALL) distance, featuring clear steps and a simplified reference system that can assist in reducing experience-dependent bias and cumulative errors. However, the following challenges remain when applying this method to the Chinese population: 1) The subjectivity in frontal bone landmarking and head position correction compromises the reproducibility of the GALL line; 2) Ethnic differences lead to a relatively anteriorly positioned GALL line, necessitating population-specific data correction; 3) Element Ⅰ imposes high requirements for preoperative orthodontic decompensation; and 4) rooted in 2D diagnosis, the six elements lack frontal and dynamic evaluation metrics. Future research should include prospective studies to validate the design efficacy. Efforts should be directed to promoting the 3D expansion of the six elements, cross-ethnic data optimization, and intelligent auxiliary tools, with the aim of providing a novel reference tool for orthognathic surgery planning. Its effectiveness remains to be validated by further prospective studies.

Key words: Andrews’ six elements, orthognathic surgery, surgical planning, goal anterior limit line, dental decompensation