Objective: To assess the accuracy of Morpheus 3D simulation software by comparing the positional differences of 17 soft
tissue landmarks between the simulated 3D image and actual post-operative 3D image.
Material and Method: 3D facial images of 20 subjects (mean age, 24+5.13 years) were taken 1 month before and 3 months
after the surgery. The virtual 3D fused images from pre-surgical digital cephalogram and 3D facial scanning were prepared.
Surgical simulation was performed with Morpheus Facemaker® software. The simulated and actual 3D image after the surgical treatment acquired from each subject were prepared, and 17 soft tissue landmarks around the nose and lips were plotted and analyzed. Statistical analysis was performed using paired t-tests (p<0.05). Intra-examiner assessments of repeatability of soft tissue landmark locations were done by Bland-Altman Limits of Agreement.
Results: No statistically significant differences were found in all the mean differences of 3D coordinate values (x, y and z) of
17 landmarks between predicted outcomes using Morpheus 3D simulator and actual postsurgical outcomes, except that the
central portion of the upper lip (Ls and Stms) showed statistically significant changes in an anterior direction on the z-axis (means 0.98 mm and 1.30 mm, respectively).
Conclusion: The soft tissue prediction algorithm provided by the Morpheus 3D Facemaker® software was found to be
sufficiently accurate in predicting soft tissue changes after orthognathic surgery. This encourages more acceptance and
confidence in the use of the simulation capabilities among clinicians, and its routine use in patient consultations.

Keywords: Morpheus 3D simulation software, Virtual 3D fused images, Simulated 3D image, Actual 3D image