Skeletal stability after sagittal split ramus osteotomy with physiological positioning in patients with skeletal mandibular prognathism and facial asymmetry

Three-dimensional condylar displacement and remodelling in patients with asymmetrical mandibular prognathism following bilateral sagittal split osteotomy

This study aims to assess the postoperative condylar displacement and the long-term condylar remodelling in patients with mandibular prognathism with transverse asymmetry after bilateral sagittal split ramus osteotomy (BSSRO). Forty-one consecutive patients (82 condyles) with a transverse mandibular asymmetry of more than 4 mm without occlusal canting treated by BSSRO were included. The preoperative (T1), immediate postoperative (T2) and long-term follow-up of an average of 16.2 months (T3) spiral computed tomography scans were gathered and processed to measure the condylar displacement and remodelling based on cranial base voxel-based and rigid regional registrations. The statistical analysis revealed that the majority of condyles (T1-T2) were transitionally displaced forwards, downwards and laterally, and were not fully returned to the preoperative position at T3. Condylar lateral displacement was significantly higher on the deviated side (DS) (P = 0.035). Non-deviated side (NDS) condyles were mainly subjected to upward pitch, medial yaw and medial roll compared with downward pitch, lateral yaw and lateral roll on DS. Condylar remodelling at T3 was observed, with the superior and posterior surfaces commonly subjected to bone resorption, whereas the anterior and medial surfaces were commonly subjected to bone apposition. Condylar volumetric changes were relatively comparable on NDS (3 ± 85.2 mm³) and DS (8.3 ± 111.7 mm³) condyles. Age, amount of preoperative asymmetry and follow-up period were not correlated with the condylar remodelling. Transitional and rotational displacements were to some extent significantly correlated with the condylar remodelling on both sides. Consequently, passive condylar seating without torque might prevent the long-term unfavourable condylar remodelling.

Type of mandibular asymmetry affects changes and outcomes of bimaxillary surgery for class III asymmetry

OBJECTIVES

Various methods have been used to classify class III asymmetry. There is little information on the use of an asymmetry index to examine soft tissue changes and outcomes for patients with class III asymmetry. This study aimed to (1) evaluate soft tissue changes and outcomes for three types of mandibular asymmetry and (2) determine if measures are associated with type of asymmetry.

MATERIALS AND METHODS

Adults who consecutively underwent bimaxillary surgery using surgery-first approach for correction of class III asymmetry were divided into three groups based on type of mandibular asymmetry. This previously reported classification system is simple and mutually independent, categorizing mandibular asymmetry according to the amount and direction of ramus asymmetry relative to menton deviation: patients with a larger transverse ramus distance on the menton deviation side were divided into group 1 and group 2; group 1 (n = 45) exhibited a menton deviation larger than ramus discrepancy; group 2 (n = 11) exhibited a menton deviation less than ramus discrepancy; group 3 (n = 22) had larger transverse ramus distance contralateral to the side of the menton deviation. Soft tissue facial asymmetry indices, calculated from cone beam computed tomography images, assessed midline and contour asymmetry presurgery, changes postsurgery, and outcomes.

RESULTS

Compared with groups 1 and 2, the presurgery index for contour and midline asymmetry was smallest for group 3. All the three groups had significant improvement in midline asymmetry postsurgery, and outcome measures were good; there were no differences between groups. However, contour asymmetry only improved significantly for groups 1 and 2. The outcome for contour asymmetry was fair for groups 1 and 3 and poor for group 2.

CONCLUSIONS

Bimaxillary surgery significantly improved facial midline asymmetry. The type of mandibular asymmetry was associated with postsurgical changes and outcomes for contour asymmetry.

CLINICAL RELEVANCE

Understanding the types of mandibular asymmetry could help clinicians to develop treatment plans and predict treatment changes and outcomes.

Relationships between jaw deformity and the occlusal plane in cone beam computed tomography scans

STATEMENT OF PROBLEM

Consistent findings about the relationships between jaw deformity and the occlusal plane are lacking.

PURPOSE

The purpose of this clinical study was to explore the relationships between the occlusal plane and jaw deformity by measuring data obtained from cone beam computed tomography (CBCT) scans.

MATERIAL AND METHODS

Reconstructed images simulated by using the Materialise Interactive Medical Image Control System (Mimics) software program of CBCT data of 80 participants with facial asymmetry and 42 participants from the normal control group were measured with a new 3-dimensional geometric morphologic measurement system. Fifteen craniofacial surfaces were marked at a point, line, or plane, measuring correlation distances and angles to analyze the relationship between jaw deformity and the inclination of the occlusal plane and other relevant facial features. The Student t test was used to analyze whether the difference in the occlusal plane between the jaw deformity group and the normal group was statistically significant (α=.05). The Pearson correlation was used to analyze the correlation among the jaw deformity, the occlusal plane, and other landmarks, and linear regression was used to analyze the relationships among them.

RESULTS

A significant difference was found between the occlusal plane of the jaw deformity and that of the normal group (P<.001) and a significant positive correlation between the degree of mandibular deformity and the inclination of occlusal plane (P<.001). A linear relationship was found between the linear regression equation of the angle of the left occlusal plane and the midsagittal sagittal plane Y and the distance between the mental apex of chin and the midsagittal plane X (the mandibular deflection to the right was defined as positive) as Y=90.646+0.388X. Statistically significant differences were found in the deviation of the chin vertex from the midsagittal plane and the distance between the midlines of the maxillary and mandibular central incisors by more than 2 mm (P<.001).

CONCLUSIONS

A positive correlation was found between the inclination of the occlusal plane and the degree of jaw deformity, with a linear relationship between them. These findings provide a theoretical basis for the clinical reconstruction of occlusal relationships with jaw deformity.

Movement of the proximal segment after intraoral vertical ramus osteotomy versus short lingual osteotomy with physiological positioning strategy

PURPOSE

To clarify whether intraoral vertical ramus osteotomy (IVRO) or short lingual osteotomy (SLO) induces less proximal segmental movement after surgery without bone fixation.

METHODS

This study included patients who underwent IVRO or SLO without bone fixation. Cephalograms were taken before surgery (T1), immediately after surgery (T2), and >6 months after surgery (T3) to assess postoperative movement of the proximal segment and skeletal stability. The condylar angle was measured using computed tomography images taken at T1 and T3 to assess rotation.

RESULTS

Ninety patients were included (IVRO, n = 25; SLO, n = 65). The proximal segment swung laterally on the frontal cephalogram in the asymmetrical IVRO group at T3. The condylar head was rotated outwardly 6.52 ± 4.49° (p < 0.0001) in the symmetrical IVRO group and 8.06 ± 6.88° (p = 0.030) on the non-deviated side in the asymmetrical IVRO group at T3. The condyles were almost stable in the SLO group. Temporomandibular joint disorders were found in 2 of 22 IVRO patients and in 2 of 42 SLO patients with asymmetry at T3.

CONCLUSION

This study suggests that SLO with the physiological positioning strategy (PPS) should be preferred over IVRO with the PPS whenever possible.

Long-term skeletal stability in the treatment of mandibular prognathism with a physiological positioning strategy

Our aim was to evaluate the long-term skeletal stability of the mandible in 21 patients after orthognathic surgery with physiological positioning. The measurement points SNB, B point (X, Y), Pog (X, Y), and the angle of the ramus were measured on cephalometric photographs to assess skeletal stability preoperatively, immediately after operation, and one and two years postoperatively. In addition, we evaluated the clinical symptoms of disorders of the temporomandibular joint (TMJ). The analysis of the cephalometric photographs showed that SNB, B point X, and Pog X showed no significant differences among the postoperative time points. On the other hand, B point Y and Pog Y showed no significant differences throughout the study period. We compared the angle of the ramus before operation and two years postoperatively, and no significant difference was found. In addition, no cases showed any pathological symptoms of disorders of the TMJ two years postoperatively. The long-term stability after orthognathic surgery with physiological positioning was confirmed, and it seems to be a reliable orthognathic treatment in patients with mandibular prognathism.