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Surgical Treatment of Dentofacial Deformities Caused by Juvenile Idiopathic Arthritis. J Craniofac Surg 2017; 29:e51-e57. [PMID: 29040144 DOI: 10.1097/scs.0000000000004029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of our retrospective study was to evaluate the results of orthognathic treatment, distraction osteogenesis, and/or prosthetic reconstruction of the temporomandibular joints in patients with juvenile idiopathic arthritis (JIA).Twelve patients with severely affected temporomandibular joints (TMJs) and reduced ramus height were treated with mandibular advancement with orthognathic surgery (11) and additional bilateral or unilateral mandibular ramus distraction (3) or additional bilateral or unilateral prosthetic reconstruction of the TMJ (3). One patient was treated surgically with bilateral TMJ prosthetic reconstruction only. The patients were followed up clinically and radiologically with emphasis on healing, TMJ function, stability of the occlusion, skeletal stability, and facial appearance for an average of 2.3 years after the final surgery. The mean mandibular advancement was 10.1 mm. The mean relapse at pogonion was 2.1 mm, which represents 20.8% of the surgical advancement. The occlusion was stable in 11/12 patients. The TMJ function was good and the facial esthetics improved in all patients. Orthognathic treatment and mandibular ramus distraction osteogenesis provide beneficial lengthening of the mandibular body in JIA patients with asymptomatic and stabile condyles. In adult patients with relapse of the disease or postoperative condylar relapse prosthetic total joint replacement is a reliable and safe alternative.
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Xi T, van Luijn R, Baan F, Schreurs R, de Koning M, Bergé S, Maal T. Three-dimensional analysis of condylar remodeling and skeletal relapse following bimaxillary surgery: A 2-year follow-up study. J Craniomaxillofac Surg 2017; 45:1311-1318. [DOI: 10.1016/j.jcms.2017.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/12/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
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Cottrell DA, Farrell B, Ferrer-Nuin L, Ratner S. Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2017; 75:e94-e125. [DOI: 10.1016/j.joms.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Tabrizi R, Nili M, Aliabadi E, Pourdanesh F. Skeletal stability following mandibular advancement: is it influenced by the magnitude of advancement or changes of the mandibular plane angle? J Korean Assoc Oral Maxillofac Surg 2017; 43:152-159. [PMID: 28770155 PMCID: PMC5529188 DOI: 10.5125/jkaoms.2017.43.3.152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/04/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives The aim of this study was to investigate the effects of advancement magnitude and changes in mandibular plane angle on the stability of mandibular advancement. Materials and Methods This retrospective cohort study evaluated the postoperative stability of mandibular advancement in class II skeletal subjects who underwent bilateral sagittal split osteotomy. Radiographs taken preoperatively, immediately postoperatively and 1 year postoperatively were traced and analyzed using linear and angular measurements. To determine horizontal and vertical relapse, an X-Y coordinate system was established in which the X-axis was constructed by rotating S-N downward by 7° (approximation of the Frankfort horizontal plane) and the Y-axis was defined as a line perpendicular to the X-axis and passing through the point Sella. For certain reference points including point A, point B, pogonion and menton, the perpendicular distance between each point and both axes was determined and cephalometric variables were recorded as X and Y coordinates. Results Twenty-five subjects were studied. A significant correlation between the amount of mandibular advancement and relapse in the B point (vertical and horizontal) and the pogonion point was observed (vertical and horizontal, P<0.001). Evaluation of data demonstrated a positive correlation between the mandibular plane angle (SN/ML) change and vertical relapse in the B point (P<0.05). A simple regression model demonstrated that 74% of horizontal relapse and 42.3% of vertical relapse in the B point was related to the amount of mandibular advancement. The receiver operating characteristic test showed that 8.5 mm mandibular advancement is related to a relapse rate of 1 mm or more in the pogonion, vertically or horizontally. Conclusion The magnitude of mandibular advancement is a stronger surgical predictor for horizontal rather than vertical relapse at the B point. Changes in mandibular plane angle (SN/ML) during surgery affect vertical, but not horizontal relapse at the B point.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Nili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Aliabadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereydoun Pourdanesh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hernández-Alfaro F, Raffaini M, Paredes-de-Sousa-Gil A, Magri AS, Guijarro-Martínez R, Valls-Ontañón A. Three-Dimensional Analysis of Long-Term Stability After Bilateral Sagittal Split Ramus Osteotomy Fixed With a Single Miniplate With 4 Monocortical Screws and 1 Bicortical Screw: A Retrospective 2-Center Study. J Oral Maxillofac Surg 2017; 75:1036-1045. [DOI: 10.1016/j.joms.2016.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/16/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
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Miao Z, Wang XD, Mao LX, Xia YH, Yuan LJ, Cai M, Liu JQ, Wang B, Yang X, Zhu L, Yu HB, Fang B. Influence of temporomandibular joint disc displacement on mandibular advancement in patients without pre-treatment condylar resorption. Int J Oral Maxillofac Surg 2017; 46:328-336. [DOI: 10.1016/j.ijom.2016.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 08/06/2016] [Accepted: 08/17/2016] [Indexed: 12/19/2022]
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Riepponen A, Myllykangas R, Savolainen J, Kilpeläinen P, Kellokoski J, Pahkala R. Changes in posterior airway space and hyoid bone position after surgical mandibular advancement. Acta Odontol Scand 2017; 75:73-78. [PMID: 27832719 DOI: 10.1080/00016357.2016.1252851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate cephalometric changes in posterior airway space (PAS) and in hyoid bone distance to mandibular plane (MP) 1-3 years after bilateral sagittal split osteotomy (BSSO). MATERIAL AND METHODS The sample consisted of 36 females and 16 males who underwent mandibular advancement by BSSO. To observe sagittal changes in PAS and in hyoid bone distance to MP both pre- and postoperative cephalograms were analyzed using WinCeph® 8.0 software. For the statistical analyses paired T-test and multivariate logistic regression models were used. RESULTS By the surgical-orthognathic treatment the sagittal dimension of PAS showed variable changes but it mainly diminished when the mandibular advancement exceeded 6 mm. In most cases the hyoid bone moved superiorly by BSSO. Logistic regression models showed that males, patients with narrow PAS at the baseline, and those with counterclockwise rotation of the mandible by the treatment gained more increase in PAS. However, an increase in sagittal PAS dimension tended to relapse over time. Concerning the movement of the hyoid it was found that the more PAS increased the less hyoid moved superiorly. In males the change in hyoid position was more obvious than in females. CONCLUSION Males, patients with narrow PAS at the baseline, and those whose mandible moved in the counterclockwise direction with moderate advancement gained more retrolingual airway patency by BSSO.
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Tsui WK, Yang Y, Cheung LK, Leung YY. Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome: A systematic review. Medicine (Baltimore) 2016; 95:e4674. [PMID: 27603361 PMCID: PMC5023883 DOI: 10.1097/md.0000000000004674] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To conduct a systematic review to answer the clinical question "What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?". METHODS A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed. RESULTS Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances. CONCLUSION This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular advancement surgery for OSAS patients and to provide a better evidence on the success and complication rates of the techniques.
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Affiliation(s)
| | - Yanqi Yang
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, People Republic of China
| | | | - Yiu Yan Leung
- Oral and Maxillofacial Surgery
- Correspondence: Dr Yiu Yan Leung, Oral and Maxillofacial Surgery, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, People Republic of China (e-mail: )
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Ghosh A, Ray A. “Converting a bi-jaw surgery to a single-jaw surgery:” Posterior maxillary dentoalveolar intrusion with microimplants to avoid the need of a maxillary surgery in the surgical management of skeletal Class III vertical malocclusion. APOS TRENDS IN ORTHODONTICS 2016. [DOI: 10.4103/2321-1407.186438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The management of a vertical skeletal Class III malocclusion with mandibular prognathism revolves around the protocol of bi-jaw surgery (maxillary LeFort I impaction and mandibular bilateral sagittal split osteotomy with setback). The maxillary surgery not only provides increased stability to the ultimate surgical outcome but also increases the amount by which the mandibular set back can be done, therefore aiding in greater profile improvement. With the need of maxillary surgery almost inevitable in treating such situations, the complexity and the increased discomfort associated with such surgery can never be ignored. Is it at all possible to convert a bi-jaw surgery into a single-jaw surgery with the aid of microimplants? With increasing number of patients being treated with microimplants for anterior openbite and gummy smiles, our idea was to incorporate this novel protocol in treating Class III vertical situations and therefore avoid the need of a maxillary surgery in treating such a situation, together with achieving optimum treatment outcome.
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Affiliation(s)
| | - Amit Ray
- Great Lakes Orthodontic Care and Fortis Medical Centre, Kolkata, West Bengal, India
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Nogami S, Yamauchi K, Satomi N, Yamaguchi Y, Yokota S, Abe Y, Takahashi T. Risk factors related to aggressive condylar resorption after orthognathic surgery for females: retrospective study. Cranio 2016; 35:250-258. [DOI: 10.1080/08869634.2016.1201886] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Norihisa Satomi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoshihiro Yamaguchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Sou Yokota
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yoko Abe
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Marangoni S, Van de Casteele E, Frigo AC, Fusetti S, Nadjmi N. Surgical treatment of class II dento-facial deformity during adolescence: Long-term follow-up. J Craniomaxillofac Surg 2016; 44:979-84. [PMID: 27269412 DOI: 10.1016/j.jcms.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/13/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the long-term stability of patients operated during adolescence on the base of clinical measurements and cephalometric analysis. Although, the potential benefits of early orthognathic surgery are known to be a reduction in treatment times and a greater healing potential leading to a better adaptation and stability of the occlusion, muscles, bones and joints, no consensus can be found in literature on the minimum age for surgical correction. MATERIALS AND METHODS In this study, thirty patients (age ≤ 15) with a class II dento-skeletal malocclusion were selected, of which 11 having a hyperdivergent (II,1) and 19 a hypodivergent (II,2) growth pattern, representing 2 distinct groups with a different treatment plan and long-term behavior. RESULTS AND CONCLUSION Observing the performance of all parameters over-time, it is seen that subjects belonging to division II,2 have a modification of the growth vectors maintaining the harmonious development between the jaws and the facial aesthetics. Less predictable is the trend in hyperdivergent patients, which are more prone to relapse in the long-term. Early surgery in these patients should be considered in the light of the degree of deformity and its influence felt by the patient on his development of self-image and interpersonal relationship.
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Affiliation(s)
- Sara Marangoni
- Department of Cranio-Maxillofacial Surgery, University of Antwerp, AZ MONICA Antwerp, Harmoniestraat 68, 2018 Antwerp, Belgium; Department of Maxillofacial Surgery, Ospedale dell' Angelo di Mestre, via Paccagnella 11, 30174 Venezia, Italy
| | - Elke Van de Casteele
- Department of Cranio-Maxillofacial Surgery, University of Antwerp, AZ MONICA Antwerp, Harmoniestraat 68, 2018 Antwerp, Belgium; All for Research vzw, Harmoniestraat 68, 2018 Antwerp, Belgium
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, Medical Statistics, University of Padova, Italy
| | - Stefano Fusetti
- Department of Maxillofacial Surgery, University of Padova, Policlinico Universitario di Padova, via Giustiani 2, 35100 Padova, Italy
| | - Nasser Nadjmi
- Department of Cranio-Maxillofacial Surgery, University of Antwerp, AZ MONICA Antwerp, Harmoniestraat 68, 2018 Antwerp, Belgium.
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Schwartz K, Rodrigo-Domingo M, Jensen T. Skeletal Stability after Large Mandibular Advancement (> 10 mm) with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation. J Oral Maxillofac Res 2016; 7:e5. [PMID: 27489609 PMCID: PMC4970505 DOI: 10.5037/jomr.2016.7205] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of the present study was to assess the skeletal stability after large mandibular advancement (> 10 mm) with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation and to correlate the skeletal stability with the vertical facial type. MATERIAL AND METHODS A total of 33 consecutive patients underwent bimaxillary surgery to correct skeletal Class II malocclusion with a mandibular advancement (> 10 mm) measured at B-point and postoperative skeletal elastic intermaxillary fixation for 16 weeks. Skeletal stability was evaluated using lateral cephalometric radiographs obtained preoperative (T1), 8 weeks postoperatively (T2), and 18 month postoperatively (T3). B-point and pogonion (Pog) was used to measure the skeletal relapse and the mandibular plane angle (MP-angle) was used to determine the vertical facial type. RESULTS The mean advancement from T1 to T2 were 11.6 mm and 13.5 mm at B-point and Pog, respectively. The mean skeletal relapse from T2 to T3 was -1.3 mm at B-point and -1.6 mm at Pog. The nineteen patients characterized as long facial types, showed the highest amount of skeletal relapse (-1.5 mm at B-point and -1.9 mm at Pog). CONCLUSIONS The present study showed a limited amount of skeletal relapse in large mandibular advancement (> 10 mm) with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation. Bilateral sagittal split osteotomy in combination with skeletal intermaxillary fixation can therefore be an alternative to distraction osteogenesis in large mandibular advancements.
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Affiliation(s)
- Kristoffer Schwartz
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark.
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
| | | | - Thomas Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark.
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Bock NC, Gnandt E, Ruf S. Occlusal stability after Herbst treatment of patients with retrognathic and prognathic facial types. J Orofac Orthop 2016; 77:160-7. [DOI: 10.1007/s00056-016-0020-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 01/21/2015] [Indexed: 10/22/2022]
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Asada K, Motoyoshi M, Tamura T, Nakajima A, Mayahara K, Shimizu N. Satisfaction with orthognathic surgery of skeletal Class III patients. Am J Orthod Dentofacial Orthop 2016; 148:827-37. [PMID: 26522044 DOI: 10.1016/j.ajodo.2015.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Class III relationships can be corrected with single-jaw or bimaxillary surgery. The purpose of this research was to assess patient satisfaction after bimaxillary surgery, compared with setback surgery alone, for Class III corrections. Identifying patients' relative levels of satisfaction will provide guidance for the selection of surgical options. METHODS The cephalometric outcomes for 25 patients who underwent 2-jaw surgery were compared with the outcomes in 40 patients who had mandibular setback. Soft and hard tissue changes were evaluated using initial and postsurgical lateral cephalograms. The patients were asked to complete self-administered questionnaires after orthognathic treatment. Correlations between cephalometric improvement and patient satisfaction were evaluated. RESULTS The patients in the 2-jaw group reported significantly higher satisfaction in the appearance of the mouth (P <0.05), smile (P <0.05), and treatment outcome (P <0.001). These item scores and the changes in ANB, ANS-M, and nasolabial angle showed strong correlations in the 2-jaw group and moderate correlations in the 1-jaw group. CONCLUSIONS ANS-M and nasolabial angle should be considered in the conventional diagnosis of skeletal Class III orthognathic surgery to obtain adequate correction of facial esthetics and patient satisfaction. Esthetic needs contribute to surgical decisions when treating patients with skeletal Class III malocclusions and dentofacial deformities such as maxillary deficiency and long facial height that causes a turned-up upper lip.
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Affiliation(s)
- Kaoru Asada
- Resident, Department of Orthodontics, School of Dentistry, Nihon University, Tokyo, Japan
| | - Mitsuru Motoyoshi
- Associate professor, Department of Orthodontics and Division of Clinical Research, Dental Research Center, School of Dentistry, Nihon University, Tokyo, Japan.
| | - Takahiko Tamura
- Clinical associate professor, Department of Orthodontics and Division of Clinical Research, Dental Research Center, School of Dentistry, Nihon University, Tokyo, Japan
| | - Akira Nakajima
- Assistant professor, Department of Orthodontics and Division of Clinical Research, Dental Research Center, School of Dentistry, Nihon University, Tokyo, Japan
| | - Kotoe Mayahara
- Assistant professor, Department of Orthodontics and Division of Clinical Research, Dental Research Center, School of Dentistry, Nihon University, Tokyo, Japan
| | - Noriyoshi Shimizu
- Professor and chair, Department of Orthodontics and Division of Clinical Research, Dental Research Center, School of Dentistry, Nihon University, Tokyo, Japan
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Evaluation of three-dimensional position change of the condylar head after orthognathic surgery using computer-aided design/computer-aided manufacturing-made condyle positioning jig. J Craniofac Surg 2015; 25:2002-7. [PMID: 24448538 DOI: 10.1097/scs.0b013e3182a246f1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study was performed to evaluate the efficacy of computer-aided design/computer-aided manufacturing (CAM/CAD)-made condyle positioning jig in orthognathic surgery. The sample consisted of 40 mandibular condyles of 20 patients with class III malocclusion who underwent bilateral sagittal split ramus osteotomy with semirigid fixation (6 men and 14 women; mean age, 25 y; mean amount of mandibular setback, 5.8 mm). Exclusion criteria were patients who needed surgical correction of the frontal ramal inclination and had signs and symptoms of the temporomandibular disorder before surgery. Three-dimensional computed tomograms were taken 1 month before the surgery (T1) and 1 day after the surgery (T2). The condylar position was evaluated at the T1 and T2 stages on the axial, frontal, and sagittal aspects in the three-dimensional coordinates. The linear change of the posterior border of the proximal segment of the ramus between T1 and T2 was also evaluated in 30 condyles (15 patients), with the exception of 10 condyles of 5 patients who received mandibular angle reduction surgery. There was no significant difference in the condylar position in the frontal and sagittal aspects (P > 0.05). Although there was a significant difference in the condylar position in the axial aspect (P < 0.01), the amount of difference was less than 1 mm and 1 degree; it can be considered clinically nonsignificant. In the linear change of the posterior border of the proximal segment of the ramus, the mean change was 1.4 mm and 60% of the samples showed a minimal change of less than 1 mm. The results of this study suggest that CAD/CAM-made condyle positioning jig is easy to install and reliable to use in orthognathic surgery.
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Xi T, de Koning M, Bergé S, Hoppenreijs T, Maal T. The role of mandibular proximal segment rotations on skeletal relapse and condylar remodelling following bilateral sagittal split advancement osteotomies. J Craniomaxillofac Surg 2015; 43:1716-22. [DOI: 10.1016/j.jcms.2015.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/30/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022] Open
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Yang HJ, Hwang SJ. Bone mineral density and mandibular advancement as contributing factors for postoperative relapse after orthognathic surgery in patients with preoperative idiopathic condylar resorption: a prospective study with preliminary 1-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:112-8. [DOI: 10.1016/j.oooo.2015.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/01/2015] [Accepted: 03/09/2015] [Indexed: 11/26/2022]
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Bilateral Sagittal Split Ramus Osteotomy Versus Distraction Osteogenesis for Advancement of the Retrognathic Mandible. J Oral Maxillofac Surg 2015; 73:1564-74. [DOI: 10.1016/j.joms.2015.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/23/2014] [Accepted: 01/03/2015] [Indexed: 11/21/2022]
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70
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Xi T, Schreurs R, van Loon B, de Koning M, Bergé S, Hoppenreijs T, Maal T. 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies. J Craniomaxillofac Surg 2015; 43:462-8. [DOI: 10.1016/j.jcms.2015.02.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/12/2014] [Accepted: 02/10/2015] [Indexed: 11/28/2022] Open
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Skeletal stability following mandibular advancement with and without advancement genioplasty. Int J Oral Maxillofac Surg 2015; 44:621-6. [DOI: 10.1016/j.ijom.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/28/2014] [Accepted: 11/06/2014] [Indexed: 11/19/2022]
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Dicker GJ, Castelijns JA, Tuinzing DB, Stoelinga PJW. Do the changes in muscle mass, muscle direction, and rotations of the condyles that occur after sagittal split advancement osteotomies play a role in the aetiology of progressive condylar resorption? Int J Oral Maxillofac Surg 2015; 44:627-31. [PMID: 25636702 DOI: 10.1016/j.ijom.2015.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/22/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Abstract
Changes in cross-sectional area (CSA), volume (indicating muscle strength), and direction of the masseter and medial pterygoid muscles after surgical mandibular advancement were measured, along with the rotation of the condyles after bilateral sagittal split osteotomies (BSSOs) to advance the mandible. Measurements were done on magnetic resonance images obtained before and 2 years after surgery. CSA and volume were measured in five short-face and seven long-face patients (five males, seven females). Muscle direction was calculated in eight short-face and eight long-face patients (eight males, eight females). Short-face patients underwent BSSO only; long-face patients underwent combined BSSO and Le Fort I osteotomies. The CSA and volume decreased significantly (mean 18%) in all patients after surgery. The postoperative muscle direction was significantly more vertical (9°) in long-face patients. Rotations of the proximal segments (condyles) were minimal after 2 years. The results of this study showed that, after BSSO advancement surgery, changes in the masseter and medial pterygoid muscles are not likely to cause increased pressure on the condyles and nor are the minimal rotations of the condyles. It is concluded that neither increased muscle traction nor condylar rotations can be held responsible for progressive condylar resorption after advancement BSSO.
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Affiliation(s)
- G J Dicker
- Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Centre, Amsterdam, Netherlands; Elkerliek Hospital, Helmond, Netherlands.
| | - J A Castelijns
- Department of Radiology, VU University Medical Centre, Amsterdam, Netherlands
| | - D B Tuinzing
- Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Centre, Amsterdam, Netherlands
| | - P J W Stoelinga
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, Netherlands; Department of Cranio-maxillofacial Surgery, Maastricht University Medical Centre, Netherlands
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73
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Herford AS, Stringer DE, Tandon R. Mandibular surgery: technologic and technical improvements. Oral Maxillofac Surg Clin North Am 2014; 26:487-521. [PMID: 25438881 DOI: 10.1016/j.coms.2014.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The ability of surgeons to use advanced techniques can significantly improve both surgical outcome and patient satisfaction. Surgical evolution in mandibular orthognathic surgery is no exception, because advancements have aided both surgical planning and technique. It is important for clinicians to be aware of the historical progression of improvements in this technique and appreciate the technologic advancements as they are happening. Computer-driven surgical planning is becoming increasingly popular, providing surgeons and patients with the ability to adjust to intraoperative and postoperative variations. By using these capabilities, clinicians are now able to give patients the best possible outcomes.
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Affiliation(s)
- Alan S Herford
- Department of Oral and Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street, 3rd Floor, Loma Linda, CA, USA.
| | - Dale E Stringer
- Department of Oral and Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street, 3rd Floor, Loma Linda, CA, USA
| | - Rahul Tandon
- Department of Oral and Maxillofacial Surgery, Parkland Memorial Hospital, University of Texas Southwestern, Dallas, TX 75390, USA
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74
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Roh YC, Shin SH, Kim SS, Sandor GK, Kim YD. Skeletal stability and condylar position related to fixation method following mandibular setback with bilateral sagittal split ramus osteotomy. J Craniomaxillofac Surg 2014; 42:1958-63. [DOI: 10.1016/j.jcms.2014.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 11/15/2022] Open
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Sahoo NK, Jayan B, Thakral A, Nagpal V. Skeletal relapse following sagittal split ramus osteotomy advancement. J Maxillofac Oral Surg 2014; 14:357-62. [PMID: 26028858 DOI: 10.1007/s12663-014-0640-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/14/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sagittal split ramus osteotomy (SSRO) is an accepted and standard procedure to address mandibular corpus deficiency. The relapse following the mandibular advancement has a negative impact both on clinician and patient. PURPOSE To analyse the hard tissue changes and to investigate relapse following SSRO advancement procedure. MATERIALS AND METHODS A retrospective review of 21 patients treated by bilateral SSRO advancement at our institute was conducted. Lateral cephalograms obtained at pre-treatment (T1), pre-surgery (T2), 2 months (T3) and 2 years post-surgery (T4) were evaluated by an independent investigator. The data T2-T3 revealed immediate postoperative changes, and T3-T4 revealed skeletal relapse following surgery after 2 years. RESULTS Twelve females and nine males with age ranging from 16 to 24 years underwent mandibular advancement. The mean follow-up period was 2 years 7 months ± 4 months. The mean mandibular advancement at pogonion was 5.1 ± 1.25 mm with significant improvement in SNB, ANB, CoGn, maxillo-mandibular differential and SN:GoPg ratio following surgery. Comparison of the outcomes following surgery revealed that the mean relapse at pogonion was 0.2 ± 0.44 mm. B point, mandibular corpus length, anterior and posterior facial height remained stable with no significant relapse following mandibular advancement. CONCLUSION Sagittal split ramus osteotomy within the range of mandibular advancement is a stable procedure.
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Affiliation(s)
- Nanda Kishore Sahoo
- Department of Dental Surgery, Armed Forces Medical College, Pune, 411040 Maharashtra India
| | - Balakrishnan Jayan
- Department of Dental Surgery, Armed Forces Medical College, Pune, 411040 Maharashtra India
| | - Ankur Thakral
- 15 Corps Dental Unit, C/O 56 APO, Pune, 903515 India
| | - Vishvaroop Nagpal
- Department of Dental Surgery, Armed Forces Medical College, Pune, 411040 Maharashtra India
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Valladares-Neto J, Cevidanes LH, Rocha WC, Almeida GDA, Paiva JBD, Rino-Neto J. TMJ response to mandibular advancement surgery: an overview of risk factors. J Appl Oral Sci 2014; 22:2-14. [PMID: 24626243 PMCID: PMC3908759 DOI: 10.1590/1678-775720130056] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022] Open
Abstract
Objective In order to understand the conflicting information on temporomandibular joint
(TMJ) pathophysiologic responses after mandibular advancement surgery, an overview
of the literature was proposed with a focus on certain risk factors. Methods A literature search was carried out in the Cochrane, PubMed, Scopus and Web of
Science databases in the period from January 1980 through March 2013. Various
combinations of keywords related to TMJ changes [disc displacement, arthralgia,
condylar resorption (CR)] and aspects of surgical intervention (fixation
technique, amount of advancement) were used. A hand search of these papers was
also carried out to identify additional articles. Results A total of 148 articles were considered for this overview and, although
methodological troubles were common, this review identified relevant findings
which the practitioner can take into consideration during treatment planning: 1-
Surgery was unable to influence TMJ with preexisting displaced disc and crepitus;
2- Clicking and arthralgia were not predictable after surgery, although there was
greater likelihood of improvement rather than deterioration; 3- The amount of
mandibular advancement and counterclockwise rotation, and the rigidity of the
fixation technique seemed to influence TMJ position and health; 4- The risk of CR
increased, especially in identified high-risk cases. Conclusions Young adult females with mandibular retrognathism and increased mandibular plane
angle are susceptible to painful TMJ, and are subject to less improvement after
surgery and prone to CR. Furthermore, thorough evidenced-based studies are
required to understand the response of the TMJ after mandibular advancement
surgery.
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Affiliation(s)
- José Valladares-Neto
- Federal University of Goiás, School of Dentistry, Department of Orthodontics, GoiâniaGO, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Lucia Helena Cevidanes
- University of Michigan, School of Dentistry, Department of Orthodontics, Ann Arbor, USA, Department of Orthodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Wesley Cabral Rocha
- General Hospital of Goiânia, Department of Oral and Maxillofacial Surgery, GoiâniaGO, Brazil, Department of Oral and Maxillofacial Surgery, General Hospital of Goiânia, Goiânia, GO, Brazil
| | - Guilherme de Araújo Almeida
- Federal University of Uberlândia, School of Dentistry, Department of Orthodontics, UberlândiaMG, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - João Batista de Paiva
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - José Rino-Neto
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Hartlev J, Godtfredsen E, Andersen NT, Jensen T. Comparative Study of Skeletal Stability between Postoperative Skeletal Intermaxillary Fixation and No Skeletal Fixation after Bilateral Sagittal Split Ramus Osteotomy: an 18 Months Retrospective Study. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 5:e2. [PMID: 24800052 PMCID: PMC4007368 DOI: 10.5037/jomr.2014.5102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/27/2014] [Indexed: 11/16/2022]
Abstract
Objectives The purpose of the present study was to evaluate
skeletal stability after mandibular advancement with bilateral sagittal
split osteotomy. Material and Methods Twenty-six patients
underwent single-jaw bilateral sagittal split osteotomy (BSSO) to correct
skeletal Class II malocclusion. One group (n = 13) were treated postoperatively
with skeletal elastic intermaxillary fixation (IMF) while the other group (n =
13) where threated without skeletal elastic IMF. Results The mean
advancement at B-point and Pog in the skeletal elastic IMF group was 6.44 mm and
7.22 mm, respectively. Relapse at follow-up at B-point was -0.74 mm and -0.29 mm
at Pog. The mean advancement at B-point and Pog in the no skeletal elastic IMF
group was 6.30 mm and 6.45 mm, respectively. Relapse at follow-up at B-point was
-0.97 mm and -0.86 mm at Pog. There was no statistical significant (P > 0.05)
difference between the skeletal IMF group and the no skeletal group regarding
advancement nor relapse at B-point or Pog. Conclusions Bilateral
sagittal split osteotomy is characterized as a stable treatment to correct Class
II malocclusion. This study demonstrated no difference of relapse between the
skeletal intermaxillary fixation group and the no skeletal intermaxillary
fixation group. Because of selection-bias and the reduced number of patients it
still remains inconclusive whether to recommend skeletal intermaxillary fixation
or not in the prevention of relapse after mandibular advancement.
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Affiliation(s)
- Jens Hartlev
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg Denmark. ; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus Denmark
| | - Erik Godtfredsen
- Section of Oral Radiology, School of Dentistry, Health, Aarhus University, Aarhus Denmark
| | - Niels Trolle Andersen
- Section of Biostatistics, School of Public Health, Health, Aarhus University, Aarhus Denmark
| | - Thomas Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg Denmark
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Landes CA, Ballon A, Tran A, Ghanaati S, Sader R. Segmental stability in orthognathic surgery: hydroxyapatite/Poly-l-lactide osteoconductive composite versus titanium miniplate osteosyntheses. J Craniomaxillofac Surg 2014; 42:930-42. [PMID: 24534684 DOI: 10.1016/j.jcms.2014.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/07/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
Abstract
Hydroxyapatite was included into F-u-HA/PLLA (unsintered hydroxyapatite - Poly l-lactide) composite osteosynthesis material for its documented osteoconductive capacity. This study investigates segmental retention capacities and outcome stability using F-u-HA/PLLA composite osteosyntheses in orthognathic surgery. Of fifty patients in total, 25 patients were osteofixated with F-u-HA/PLLA osteoconductive bioabsorbable osteosyntheses and compared to a group of 25 patients treated with titanium miniplates. The F-u-HA/PLLA group included 14 maxillary advancements, 4 setbacks, 13 impactions, 5 elongations at A-point; the titanium group included 20 maxillary advancements, 2 setbacks, 11 impactions and 11 elongations. In the mandible the F-u-HA/PLLA group included 13 advancements at B-point, 11 setbacks, 16 clockwise rotations and 8 counterclockwise rotations at the Gonial angle (Ar-Go-Gn); the titanium group included 9 mandibular advancements, 5 setbacks, 8 clockwise rotations and 6 counterclockwise rotations at Ar-Go-Gn. Segmental stability and relapse were assessed comparing preoperative, postoperative and follow-up roentgen cephalometrics at 22 ± 11 months on average in F-u-HA/PLLA cases, 24 ± 22 months on average in the titanium group. All absolute operative movements were nonsignificant in the F-u-HA/PLLA cases compared to the titanium osteosynthesis cases. Relapses were nonsignificant but there was greater vertical relapse in maxillary impactions with titanium osteosyntheses. Throughout this study, F-u-HA/PLLA composite osteosyntheses appeared as stable as titanium miniplates. It can therefore be concluded, although from a limited number of patients, that the investigated osteoconductive osteosynthesis can be used in a similar way to titanium miniplates in orthognathic surgery. Compared to earlier studies using other bioabsorbable polymers in the literature, F-u-HA/PLLA proved to be more stable in segmental retention.
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Affiliation(s)
- Constantin A Landes
- Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany.
| | - Alexander Ballon
- Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany.
| | - Andreas Tran
- Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
| | - Shahram Ghanaati
- Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
| | - Robert Sader
- Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany
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Chen S, Lei J, Wang X, Fu KY, Farzad P, Yi B. Short- and Long-Term Changes of Condylar Position After Bilateral Sagittal Split Ramus Osteotomy for Mandibular Advancement in Combination With Le Fort I Osteotomy Evaluated by Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2013; 71:1956-66. [DOI: 10.1016/j.joms.2013.06.213] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 06/16/2013] [Accepted: 06/19/2013] [Indexed: 12/16/2022]
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Guglielmi M, Schneider KM, Iannetti G, Feng C, Martinez AY. Orthognathic Surgery for Correction of Patients With Mandibular Excess: Don’t Forget to Assess the Gonial Angle. J Oral Maxillofac Surg 2013; 71:1063-72. [DOI: 10.1016/j.joms.2012.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 11/15/2022]
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Effect of intended manual condylar positioning on skeletal and dental changes in Skeletal Class III deformities: CBCT-generated half-cephalograms. J Craniomaxillofac Surg 2013; 42:7-12. [PMID: 23434240 DOI: 10.1016/j.jcms.2013.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/29/2012] [Accepted: 01/15/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION To investigate the effect of intended manual condylar positioning on skeletal changes from preoperative stage to posttreatment stage. MATERIALS AND METHODS The sample comprised 23 patients divided into two groups according to surgery type: mandible-only setback surgery (group I) versus 2-jaw surgery (group II). CBCT-generated Half-Cephalograms were fabricated to evaluate the skeletal, dental, and condylar positioning changes for each subject at three time points (preoperatively (T0), immediate-postoperatively (T1), and posttreatment (T2)). RESULTS The angle of the proximal segment in group II was reduced immediate-postoperatively. In both groups, the result showed a negative mean value for the horizontal mandibular position (B point to N-perpendicular plane at T2-T1 stage). In group II, the vertical mandibular position (B point to FH plane at T2-T1 stage) also had a negative mean value. In group I, the change of the B point to N-perpendicular plane (T2-T1) had statistically significant correlations with the change of the Cd to Po-perpendicular plane (T2-T1). In group II, the change of the B point to the N-perpendicular plane (T2-T1) had statistically significant correlations with the change of the <Cd-Cp-FH plane angle (T2-T1) and the Cp to FH plane (T1-T0). CONCLUSIONS In this study, the change from the T1 to T2 stage, though not statistically significant, showed a negative short-term relapse. Intended manual condylar positioning may suppress the short-term skeletal relapse.
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82
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Cottrell DA, Edwards SP, Gotcher JE. Surgical correction of maxillofacial skeletal deformities. J Oral Maxillofac Surg 2013; 70:e107-36. [PMID: 23127998 DOI: 10.1016/j.joms.2012.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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83
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Ghang MH, Kim HM, You JY, Kim BH, Choi JP, Kim SH, Choung PH. Three-dimensional mandibular change after sagittal split ramus osteotomy with a semirigid sliding plate system for fixation of a mandibular setback surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:157-66. [DOI: 10.1016/j.oooo.2012.02.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/06/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
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84
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Beukes J, Reyneke J, Becker P. Medial pterygoid muscle and stylomandibular ligament: the effects on postoperative stability. Int J Oral Maxillofac Surg 2013; 42:43-8. [DOI: 10.1016/j.ijom.2012.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
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den Besten CA, Mensink G, van Merkesteyn JPR. Skeletal stability after mandibular advancement in bilateral sagittal split osteotomies during adolescence. J Craniomaxillofac Surg 2012; 41:e78-82. [PMID: 23253633 DOI: 10.1016/j.jcms.2012.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 11/10/2012] [Accepted: 11/12/2012] [Indexed: 11/19/2022] Open
Abstract
Bilateral sagittal split osteotomy (BSSO) is the most frequently performed surgery for correcting mandibular retrognathia. Few studies have reported the use of BSSO in young patients, as growth may cause relapse. The aim of the present study was to determine the amount of relapse after performing BSSO in patients aged less than 18 years. Patients who had a mandibular advancement by BSSO surgery between January 2003 and June 2008 were evaluated. Eighteen patients were treated before the age of 18 years and compared with patients treated at 20-24 years of age. Cephalometric radiographs were used to determine the amount of relapse. For patients aged less than 18 years, the mean horizontal relapse after 1 year was 0.5 mm, (10.9% of perioperative advancement). For patients aged 20-24 years, the mean relapse was 0.9 mm, (16.4% of perioperative advancement). There were no significant differences between the age groups (p > 0.05). In conclusion, the BSSO procedure is a relatively stable procedure, even during adolescence.
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Affiliation(s)
- C A den Besten
- Department of Oral and Maxillofacial surgery, Leiden University Medical Center, Leiden, The Netherlands
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86
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Van Sickels JE, Wallender A. Closure of anterior open bites with mandibular surgery: advantages and disadvantages of this approach. Oral Maxillofac Surg 2012; 16:361-367. [PMID: 22945345 DOI: 10.1007/s10006-012-0361-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/18/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION While closure of an anterior open bite with a mandibular procedure may predispose a surgical case to instability, there are instances where this type of treatment planning is indicated. METHODS AND MATERIALS In this paper, the authors review the advantages and disadvantages of this approach and present three cases with varying degrees of success. Additionally, treatment strategies are presented for managing large advancements of the maxilla and mandible. RESULTS AND SUMMARY Counterclockwise rotation of the mandible is a valuable tool that can be used in the treatment of patients with dentofacial deformities.
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Affiliation(s)
- Joseph E Van Sickels
- Division of Oral and Maxillofacial Surgery, Chandler Medical Center, College of Dentistry, University of Kentucky, 800 Rose Street, D-508, Lexington, KY 40536-0297, USA.
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Costello BJ, Rivera RD, Shand J, Mooney M. Growth and Development Considerations for Craniomaxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2012; 24:377-96. [DOI: 10.1016/j.coms.2012.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ballon A, Laudemann K, Sader R, Landes CA. Segmental stability of resorbable P(L/DL)LA-TMC osteosynthesis versus titanium miniplates in orthognatic surgery. J Craniomaxillofac Surg 2012; 40:e408-14. [PMID: 22503082 DOI: 10.1016/j.jcms.2012.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022] Open
Abstract
After two decades of the use of resorbable miniplates, new polymer compositions for resorbable osteosynthesis are still being developed to make the handling and outcome of operations even more predictable and give higher stability to the repositioned segments. This study investigates a new resorbable osteosynthesis system in orthognathic patients. 50 patients were treated with P(L/DL)LA-TMC resorbable osteosynthesis and compared to a group of 50 patients treated with titanium miniplates. Segmental stability and relapse were measured comparing preoperative, postoperative and follow-up lateral cephalograms. Throughout this study, resorbables appeared to be as stable as titanium miniplates except in maxillary elongation and mandibular setback. Here, the titanium miniplates showed significantly higher stability than resorbable plates. P(L/DL)LA-TMC osteosynthesis seem to have less strength against compressive forces after maxillary elongation and they are less resistant to the forces the tongue exerts, pressing against the mandible after setback. It can therefore be concluded that the resorbable osteosynthesis can be used in the same situations as titanium miniplates except in maxillary elongation and mandibular setback.
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Affiliation(s)
- Alexander Ballon
- Department of Oral Maxillofacial and Plastic Facial Surgery, University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany.
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Dicker GJ, Koolstra JH, Castelijns JA, Van Schijndel RA, Tuinzing DB. Positional changes of the masseter and medial pterygoid muscles after surgical mandibular advancement procedures: an MRI study. Int J Oral Maxillofac Surg 2012; 41:922-9. [PMID: 22418077 DOI: 10.1016/j.ijom.2012.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 11/21/2011] [Accepted: 01/13/2012] [Indexed: 11/24/2022]
Abstract
This study evaluated whether surgical mandibular advancement procedures induced a change in the direction and the moment arms of the masseter (MAS) and medial pterygoid (MPM) muscles. Sixteen adults participated in this study. The sample was divided in two groups: Group I (n=8) with a mandibular plane angle (mpa) <39° and Group II (n=8) with an mpa >39°. Group I patients were treated with a bilateral sagittal split osteotomy (BSSO). Those in Group II were treated with a BSSO combined with a Le Fort I osteotomy. Pre- and postoperative direction and moment arms of MAS and MPM were compared in these groups. Postsurgically, MAS and MPM in Group II showed a significantly more vertical direction in the sagittal plane. Changes of direction in the frontal plane and changes of moment arms were insignificant in both groups. This study demonstrated that bimaxillary surgery in patients with an mpa >39° leads to a significant change of direction of MAS and MPM in the sagittal plane.
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Affiliation(s)
- G J Dicker
- Department of Oral and Maxillofacial Surgery/Pathology, Academic Centre for Dentistry Amsterdam (ACTA) and VU University Medical Center, Amsterdam, The Netherlands.
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Sharshar HH, El-Bialy TH. Cephalometric evaluation of airways after maxillary anterior advancement by distraction osteogenesis in cleft lip and palate patients: a systematic review. Cleft Palate Craniofac J 2011; 49:255-61. [PMID: 21740172 DOI: 10.1597/11-031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was conducted to review the changes in airways after maxillary anterior advancement by distraction osteogenesis in patients with cleft lip and palate. MATERIALS AND METHODS Several electronic databases were searched. The selection criteria were set to include clinical trials and at least 1 year of postsurgical data. The original articles were then retrieved and evaluated by two investigators to ensure that they met the selection criteria. The references were also hand searched for possible missing articles. RESULTS Forty-three abstracts were found in the electronic searches. After the first set of selection criteria was applied to these abstracts, 14 articles were retrieved. After the final selection criteria, only four articles were finally selected. However, sample sizes of the selected articles were small, and the methodological quality of the studies was inadequate. All selected articles were consistent in that upper airway sizes increased and nasal resistance was reduced after distraction osteogenesis. CONCLUSIONS Despite the consistency of increasing the upper airway size and reducing nasal resistance in the only four found articles, limitations of the studies merit caution in interpreting these findings. We conclude that there are insufficient prospective randomized controlled clinical trials to confirm these results.
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Affiliation(s)
- Hossam H Sharshar
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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91
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Moen K, Wisth PJ, Skaale S, Bøe OE, Tornes K. Dental or skeletal relapse after sagittal split osteotomy advancement surgery? Long-term follow-up. J Oral Maxillofac Surg 2011; 69:e461-8. [PMID: 21741141 DOI: 10.1016/j.joms.2011.02.086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/11/2011] [Accepted: 02/12/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the short- and long-term stability of mandibular advancement surgery with sagittal split osteotomy (SSO), and to investigate when relapse occurs and identify variables contributing to relapse. PATIENTS AND METHODS Thirty-six patients with Class II anomalies were included; the mean age at surgery was 33.0 years. All underwent SSO surgery and clinical and radiologic follow-up at 8 weeks, 1 year, and 13 years. Model analysis, cephalometric analysis, and clinical examinations were performed at each control. RESULTS Mean overjet relapse from 8 weeks to 13 years was 2.3 mm (range, 0 to 7.0 mm). Between 8 weeks and 1 year, mean overjet relapse was 0.6 mm (range, -1.0 to 4.0 mm), and it was 1.7 mm (range, -1.0 to 6.0 mm) between 1 year and 13 years. Overjet relapse greater than 4 mm was found in 13.9% of the patients. Mean overjet 1 year after surgery was 2.6 mm and was significantly increased compared with 8 weeks (P = .006). Mean overjet 13 years after surgery was 4.3 mm and was significantly increased compared with 1 year (P < .001). Inferior incisor line to nasion-B-point was 29.0° at 8 weeks after surgery and 25.4° at 13 years (P = .001). Insignificant changes in the other cephalometric variables were found at follow-up. CONCLUSION SSO advancement surgery is a relatively stable technique over time. Mean overjet relapse was found to be 2.3 mm after 13 years, following a continuous pattern over time. The cephalometric variables showed insignificant changes during follow-up, indicating that relapses are mainly of dental and not skeletal origin.
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Affiliation(s)
- Ketil Moen
- Section of Oral and Maxillofacial Surgery, Department of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
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92
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Kim YI, Cho BH, Jung YH, Son WS, Park SB. Cone-beam computerized tomography evaluation of condylar changes and stability following two-jaw surgery: Le Fort I osteotomy and mandibular setback surgery with rigid fixation. ACTA ACUST UNITED AC 2011; 111:681-7. [DOI: 10.1016/j.tripleo.2010.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/16/2010] [Accepted: 08/02/2010] [Indexed: 10/18/2022]
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93
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Jakobsone G, Stenvik A, Sandvik L, Espeland L. Three-year follow-up of bimaxillary surgery to correct skeletal Class III malocclusion: stability and risk factors for relapse. Am J Orthod Dentofacial Orthop 2011; 139:80-9. [PMID: 21195281 DOI: 10.1016/j.ajodo.2009.03.050] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 03/01/2009] [Accepted: 03/01/2009] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate long-term skeletal and occlusal stability after bimaxillary surgery to correct skeletal Class III malocclusion. METHODS The sample comprised 81 consecutively treated patients. All subjects had received a combined 1-piece LeFort I and bilateral sagittal split ostotomies with rigid fixation between 1990 and 2003 and were followed for 3 years. Lateral cephalograms were obtained before surgery and at 5 occasions after surgery. RESULTS The mean setback was 6.9 mm in the mandible, and the maxilla was moved forward 3.7 mm. In most patients, the posterior maxilla was impacted. Relapse of maxillary advancement was insignificant (0.1 mm), whereas relapse at B-point was on average 1.7 mm (P <0.010). After 3 years, mean overjet and overbite amounts were 2.0 and 1.9 mm, respectively. Skeletal relapse of the mandible increased significantly with the surgical setback (P <0.001) and the change in the vertical position of the posterior maxilla (P = 0.010) (multivariate regression analysis). CONCLUSIONS Bimaxillary surgery resulted in good occlusal stability. Maxillary advancement was stable, whereas relapse of the mandibular setback varied. Risk factors for horizontal relapse of the mandible were large setback and inferior repositioning of the posterior maxilla.
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94
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Park HS, Kim JY, Kwon TG. Occlusal plane change after intrusion of maxillary posterior teeth by microimplants to avoid maxillary surgery with skeletal Class III orthognathic surgery. Am J Orthod Dentofacial Orthop 2010; 138:631-40. [DOI: 10.1016/j.ajodo.2008.09.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 09/01/2008] [Accepted: 09/01/2008] [Indexed: 11/28/2022]
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95
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Baccetti T, McNamara JA. The impact of functional jaw orthopedics in subjects with unfavorable Class II skeletal patterns. Prog Orthod 2010; 11:118-26. [PMID: 20974448 DOI: 10.1016/j.pio.2010.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 07/12/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the outcomes of functional jaw orthopedics (FJO) followed by fixed appliances in Class II patients showing cephalometric signs predictive of unfavorable responsiveness to orthopedic treatment. MATERIALS AND METHODS A total of 48 treated subjects (20 males, 28 females) with unfavorable Class II malocclusions were treated with FJO at the adolescent growth spurt, followed by fixed appliances. Treatment outcomes were compared with the growth changes in a matched control group of untreated subjects with "unfavorable" Class II malocclusions. RESULTS A significant prevalence rate of successful outcome was recorded within the treated group (64.5%). When compared with the untreated controls, both the overall treated group and the successful treated subgroup revealed a significant reduction in maxillary growth and sagittal position, along with a significant enhancement in mandibular length, sagittal advancement of the mandible, and significant improvements in the maxillo-mandibular relationships. Both overjet and molar relation showed significant favorable changes in the treated group. CONCLUSIONS FJO at the pubertal spurt followed by fixed appliances is a viable therapeutical option in patients with "unfavorable" Class II malocclusions, although skeletal changes are of minor entity.
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96
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Changing skeletal pattern by means of osteogenesis distraction: a new therapeutic approach to patients with dysmorphism. J Craniofac Surg 2010; 21:1608-10. [PMID: 20818251 DOI: 10.1097/scs.0b013e3181ecc2b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The correction of class II high-angle open-bite in patients is difficult to achieve by traditional and conventional techniques in occlusal stability and function. The authors propose a new approach to a patient with dysmorphism (class II, short ramus, and open bite) using distraction osteogenesis to change the skeletal pattern of patients with high-angle class II to low-angle class III before undergoing traditional orthognathic surgery. This new approach is based on osteogenesis distraction, emphasizing planning and surgical procedures.
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97
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Baas E, de Lange J, Horsthuis R. Evaluation of alveolar nerve function after surgical lengthening of the mandible by a bilateral sagittal split osteotomy or distraction osteogenesis. Int J Oral Maxillofac Surg 2010; 39:529-33. [DOI: 10.1016/j.ijom.2010.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 01/18/2010] [Accepted: 03/16/2010] [Indexed: 11/26/2022]
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98
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99
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Proffit WR, Phillips C, Turvey TA. Long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency. Int J Oral Maxillofac Surg 2010; 39:327-32. [PMID: 20181460 DOI: 10.1016/j.ijom.2010.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 12/15/2009] [Accepted: 01/20/2010] [Indexed: 11/25/2022]
Abstract
In mandibular deficient patients, mandibular growth is not expected after the adolescent growth spurt, so mandibular advancement surgery is often carried out at 13 years. To test if the long-term stability for younger patients is similar to that for adult patients, the authors compared cephalometric changes from 1-year postsurgery (when changes due to the surgery should be completed) to 5-year follow up. 32 patients who had early mandibular advancement with or without simultaneous maxillary surgery (aged up to 16 for girls and 18 for boys), and 52 patients with similar surgery at older ages were studied. Beyond 1-year postsurgery, the younger patients showed significantly greater change in the horizontal and vertical position of points B and pogonion, the horizontal (but not vertical) position of gonion, and mandibular plane angle. 50% of younger patients had 2-4mm backward movement of Pg and another 25% had >4mm. 15% of older patients had 2-4mm change and none had >4mm. Long-term changes in younger patients who had two-jaw surgery were greater than for mandibular advancement only. Changes in younger groups were greater than for adult groups. Satisfaction with treatment and perception of problems were similar for both groups.
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Affiliation(s)
- W R Proffit
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA.
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Mandibular hypoplasia with curvilinear distraction. J Craniofac Surg 2010; 21:168-73. [PMID: 20072008 DOI: 10.1097/scs.0b013e3181c50ff3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mandibular distraction with intraoral curvilinear distractor is an effective procedure for lengthening the mandibular corpus and ramus dimensions. Mandibular distractor is valuable for the treatment of hypoplastic mandible. The aim of this article was to describe the treatment of a patient with hypoplastic and severely retrognathic mandible resulting from isolated Pierre Robin sequence, by means of curvilinear distraction osteogenesis followed by fixed orthodontic treatment. As a result, the curvilinear path of distraction can form a new mandibular angle and bring the mandible significantly forward. Attention should be given for the stability of the treatment results.
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