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Kim JY, Yong HS, Kim TY, Kim JY, Jeon KJ, Huh JK. Volumetric changes in temporomandibular joint space following trans-oral vertical ramus osteotomy in patients with mandibular prognathism: a one-year follow-up study. Sci Rep 2024; 14:942. [PMID: 38200085 PMCID: PMC10781718 DOI: 10.1038/s41598-023-51050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
This study measured and analyzed chronological changes in temporomandibular joint space volume by compartment following transoral vertical ramus osteotomy (TOVRO) using reconstructed 3-dimensional (3D) images of patients with mandibular prognathism. It included 70 joints of 35 patients who underwent TOVRO between January 2018 and December 2021. Computed tomography (CT) or cone-beam CT (CBCT) was performed before surgery (T0) and at 3 days (T1), 6 months (T2), and 12 months postoperatively (T3). These scans were then analyzed using 3D software. The volumes of the overall (Vjs), anterior (Vajs), posterior (Vpjs), medial (Vmjs), and lateral (Vljs) joint spaces were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used to evaluate significant changes in joint space volume over time. Vjs significantly increased to 134.54 ± 34.28 mm3 at T3 compared to T0 (p < 0.001). Vpjas and Vljs increased by 130.72 ± 10.07 mm3 and 109.98 ± 7.52 mm3 at T3 compared to T0, respectively (p < 0.001). However, no significant difference was observed between T0 and T2 in Vajs and Vmjs (p = 0.9999). The observed volume increases in Vpjs and Vljs appeared to contribute to the overall Vjs increase.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Hae-Seong Yong
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Tae-Yeong Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Jun-Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea.
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Kang SH, Kang MJ, Kim MJ, Kim MK. Changes in facial width according to the ostectomy level of the proximal bone segment in intraoral vertical ramus osteotomy for mandibular prognathism. Maxillofac Plast Reconstr Surg 2022; 44:16. [PMID: 35435520 PMCID: PMC9016097 DOI: 10.1186/s40902-022-00347-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the changes in facial width according to the ostectomy level of the proximal segment after orthognathic surgery using intraoral vertical ramus osteotomy (IVRO) in patients with mandibular prognathism. Methods The participants included 32 individuals who were diagnosed with class III malocclusion prior to surgery. All participants underwent orthognathic surgery using either version of IVRO. The surgery patients were categorized into two groups depending on the type of proximal bone-segment ostectomy technique used: patients whose osteotomy height was at the level of the mandibular tooth occlusal surface (the mandibular tooth surface–level group) and patients whose osteotomy height was at the level of the mandibular inferior border (the mandibular inferior border–level group). The distances between the mandibular width and soft tissue width at the height of the sigmoid notch, mandibular foramen, and alveolar bone and at the anterior-posterior location of the mandibular condyle, mandibular foramen, and coronoid process were compared between the groups. All data were compared to identify differences between preoperative and postoperative measurements. Results The postoperative change in facial soft tissue width at the intersection of the coronal plane with the coronoid process and the horizontal plane at the height of the mandibular alveolar bone in the group with osteotomy at the level of the mandibular occlusal surface differed significantly from that in the group with osteotomy at the level of the mandibular inferior border, with respective increases (mean ± SD) of 1.3 ± 3.5% and 4.7 ± 5.6%, compared to preoperative measurements (p = 0.050). Conclusions Proximal segment ostectomy at the level of the mandibular occlusal surface must be considered with regard to postoperative facial soft tissue width in vertical ramus osteotomy. Additionally, it is necessary to study the visual effect of the width of the mandible appearing small because of the posterior position of the mandible, even when the mandibular facial width is maintained.
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Song SH, Kim JY, Lee SH, Park JH, Jung HD, Jung YS. Three-Dimensional Analysis of Transverse Width of Hard Tissue and Soft Tissue After Mandibular Setback Surgery Using Intraoral Vertical Ramus Osteotomy: A Retrospective Study. J Oral Maxillofac Surg 2018; 77:407.e1-407.e6. [PMID: 30439330 DOI: 10.1016/j.joms.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width, leading to esthetically unfavorable results. This study investigated short- and long-term postoperative transverse mandibular width changes in the soft and hard tissue after IVRO for mandibular prognathism. MATERIALS AND METHODS The study comprised 44 patients who were treated with mandibular setback surgery using an IVRO. They were categorized into either the facial symmetry group or facial asymmetry group based on their preoperative levels of chin top deviation. Three-dimensional cone-beam computed tomography images were obtained at the preoperative, 1-month postoperative, and 12-month postoperative stages, designated as T1, T2, and T3, respectively. We set hard tissue width 1 (HW1) and hard tissue width 2 (HW2) as the sum of the distance at the bilateral ends of the angle and ramus, respectively, and set soft tissue width 1 (SW1) and soft tissue width 2 (SW2) as the sum of the distance at the bilateral ends of the soft tissue angle and ramus, respectively. RESULTS Compared with the value at T1, the HW1 value increased by 8.16% (P < .05) and HW2 increased by 4.39% (P > .05) at T2; HW1 increased by 4.35% (P < .05) and HW2 increased by 2.95% (P > .05) at T3. Compared with the value at T1, the SW1 value increased by 2.49% and SW2 increased by 2.50% at T2; however, SW1 decreased by 0.85% and SW2 increased by 0.37% at T3. The soft tissue variations between T1 and T2, as well as between T2 and T3, were statistically significant. However, no significant difference was found between T1 and T3 (P > .05). No difference between the facially symmetrical and asymmetrical groups was found over time for soft and hard tissues (P > .05). CONCLUSIONS Notably, IVRO does not seem to impact the transverse facial profile and enables reliable prediction of the esthetic results of surgery.
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Affiliation(s)
- Sang Hyun Song
- Resident, Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jun-Young Kim
- Fellow, Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Sung Hwa Lee
- Former Resident, Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jin Hoo Park
- Fellow, Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hwi-Dong Jung
- Associate Professor, Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Young-Soo Jung
- Professor, Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea.
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Huh JW, Kim SY, Lee YB, Park JH, Jung HD, Jung YS. Three-dimensional changes of proximal segments in facial asymmetry patients after bilateral vertical ramus osteotomy. Int J Oral Maxillofac Surg 2018; 49:1036-1041. [PMID: 29776719 DOI: 10.1016/j.ijom.2018.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 10/25/2022]
Abstract
The intraoral vertical ramus osteotomy (IVRO) is a useful technique for mandibular setback surgery. However, there is a tendency for lateral flaring of the proximal segments on the non-deviation side after the correction of mandibular asymmetry with this technique. The purpose of this retrospective study was to evaluate the positional changes of the proximal segments after IVRO setback in skeletal class III patients with asymmetry, using preoperative and postoperative computed tomography scan data, and to apply the results in clinical practice. A total of 28 skeletal class III patients with asymmetry who underwent bimaxillary orthognathic surgery were included. A three-dimensional cone beam computed tomography scan was obtained preoperative, at 1month postoperative, and at 1year postoperative. At 1month after the surgery, the proximal segments showed an outward rotation, lateral flaring, and anterior rotation of the condylar head. All postsurgical directional changes had returned to the preoperative state at 1year postoperative, and there was no statistically significant difference in postoperative angulation changes between the two sides. The results showed no statistical differences in the positional changes of the proximal segments between the deviation and non-deviation sides. This study reaffirms the benefits of the IVRO for a minimal bony interference between the proximal and distal segments in three dimensions, including mandibular asymmetry cases.
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Affiliation(s)
- J W Huh
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, South Korea
| | - S Y Kim
- Private Practice, McLean, Virginia, USA
| | - Y-B Lee
- Department of Oral and Maxillofacial Surgery, Hankook General Hospital, Cheongju, South Korea
| | - J H Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, South Korea
| | - H-D Jung
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Y-S Jung
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, South Korea.
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Three-Dimensional Analysis of Midfacial Soft Tissue Changes After Maxillary Posterior Impaction and Intraoral Vertical Ramus Osteotomy for Mandibular Setback in Class III Patients. J Craniofac Surg 2017; 28:1789-1796. [DOI: 10.1097/scs.0000000000003754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Singh V, Sudhakar KNV, Mohanty R, Chatterjee S. Orthognathic Surgery: A Review of Articles Published in 2014-2015. J Maxillofac Oral Surg 2017; 16:284-291. [PMID: 28717285 PMCID: PMC5493559 DOI: 10.1007/s12663-016-0990-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/04/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published. METHOD A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea. RESULTS Bulk of the studies were retrospective, and less interest was shown onto experimental researches. CONCLUSION A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.
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Affiliation(s)
- Vaibhav Singh
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Kiit University, Bhubaneswar, 751024 India
| | - K. N. V. Sudhakar
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Kiit University, Bhubaneswar, 751024 India
| | - Rajat Mohanty
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Bhubaneswar, India
| | - Suravi Chatterjee
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Bhubaneswar, India
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Kawase-Koga Y, Mori Y, Fujii Y, Kanno Y, Chikazu D, Susami T, Takato T. Complications after intraoral vertical ramus osteotomy: relationship to the shape of the osteotomy line. Int J Oral Maxillofac Surg 2015; 45:200-4. [PMID: 26421477 DOI: 10.1016/j.ijom.2015.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 05/06/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022]
Abstract
Intraoral vertical ramus osteotomy (IVRO) is used widely to correct mandibular prognathism. However, several disadvantages of this procedure have been reported, such as condylar luxation and bony interference at the osteotomy site. The aim of this study was to survey the incidence of complications (condylar luxation and bony interference) based on the shape of the osteotomy line. One hundred and eighty-five rami in 118 patients with jaw deformities, which were treated with IVRO, were examined retrospectively. The shape of the osteotomy line and the postoperative complications were examined on panoramic radiographs. Osteotomy lines were classified into three types: vertical, C-shaped, and oblique. Of the 185 osteotomy sites, 98 were vertical, 37 C-shaped, and 50 oblique. Condylar luxation was found in six rami (3.2%); four had undergone vertical osteotomy and two had undergone C-shaped osteotomy. Bony interference occurred in seven rami (3.8%), all with vertical type osteotomy lines. Most complications occurred in the vertical type cases and no complications were found in oblique type cases. Condylar luxation was found mainly in unilateral IVRO cases and bony interference was found in bilateral IVRO cases. These results suggest that the oblique type of osteotomy line has the advantage of avoiding complications.
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Affiliation(s)
- Y Kawase-Koga
- Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
| | - Y Mori
- Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Tokyo, Japan; Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University, Tochigi, Japan
| | - Y Fujii
- Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Y Kanno
- Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Tokyo, Japan
| | - D Chikazu
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - T Susami
- Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Tokyo, Japan
| | - T Takato
- Department of Oral and Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Tokyo, Japan
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Stability of Pre-Orthodontic Orthognathic Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Treatment. J Oral Maxillofac Surg 2015; 74:610-9. [PMID: 26259691 DOI: 10.1016/j.joms.2015.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/03/2015] [Accepted: 07/15/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Postoperative skeletal and dental changes were evaluated in patients with mandibular prognathism who underwent mandibular setback surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment. MATERIAL AND METHODS This retrospective cohort study included consecutive patients with skeletal Class III malocclusions who underwent IVRO. Patients treated with pre-orthodontic orthognathic surgery (POGS) were compared with patients treated with conventional surgery (CS) with presurgical orthodontics (control) using lateral cephalograms (taken preoperatively, 7 days postoperatively, and 12 months postoperatively). Predictor (group and timing), outcome (cephalometric measurements over time), and other (ie, baseline characteristics) variables were evaluated to determine the differences in postoperative horizontal and vertical positional changes of the mandible, such as point B. Baseline demographics were similar between the groups (N = 37; CS group, n = 17; POGS group, n = 20). The data were analyzed with an independent t test, the Mann-Whitney U test, the Fisher exact t test, Pearson correlation analysis, and simple linear regression analysis. RESULTS The mean setback of the mandible at point B was similar, but the mandible of the POGS group, particularly the distal segment, moved superiorly during the postoperative period in conjunction with the removal of premature occlusal contacts (P < .001). In the CS group, the mandible had significantly more backward movement 12 months after surgery compared with the POGS group (P < .01). In the POGS group, horizontal and vertical postsurgical changes were linearly correlated with the amount of setback and vertical movement of the mandible. CONCLUSIONS Mandibular setback surgery using IVRO without presurgical orthodontics leads to considerably different postoperative skeletal and dental changes compared with conventional treatment, with more superior movement being observed at point B during the 1-year postoperative period.
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Jung HD, Kim SY, Park HS, Jung YS. Orthognathic surgery and temporomandibular joint symptoms. Maxillofac Plast Reconstr Surg 2015; 37:14. [PMID: 26029683 PMCID: PMC4446569 DOI: 10.1186/s40902-015-0014-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/22/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.
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Affiliation(s)
- Hwi-Dong Jung
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Sang Yoon Kim
- Private Practice Vienna VA; Former resident Harvard Oral & Maxillofacial Surgery, Boston, MA USA
| | - Hyung-Sik Park
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Young-Soo Jung
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
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