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Hupp LC, Verius M, Kolk A, Emshoff R. Do Surgical Intervention Type and Baseline Condylar Position Affect Spatial Dimension Changes of the Temporomandibular Joint in the Surgical Correction of Skeletal Class II Deformities? J Oral Maxillofac Surg 2024:S0278-2391(24)00276-3. [PMID: 38750659 DOI: 10.1016/j.joms.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 03/09/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND One of the key features of orthognathic surgery is altering temporomandibular joint (TMJ) condylar positions. PURPOSE This multivariate study aimed to identify surgical interventions and patient factors significantly associated with changes in TMJ spatial dimensions after the surgical correction of skeletal Class II deformities. STUDY DESIGN, SETTING, SAMPLE This is a retrospective cohort study including patients who had undergone an isolated bilateral sagittal split ramus osteotomy (BSSO) or a bimaxillary osteotomy (BMO) for mandibular advancement and a control sample of patients treated with the removal of odontogenic cysts in the mandibular posterior region. Excluded were those who presented with specific radiographic signs of TMJ osteoarthrosis, severe facial asymmetry, or deformity secondary to trauma. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictors were condylar position at baseline (anterior, concentric, and posterior), time points (T0, preoperatively; T1, immediately after surgery; and T2, 1-year follow-up), and surgical intervention type (BSSO, BMO, and control group). MAIN OUTCOME VARIABLES The primary outcomes were changes in posterior spatial dimension (PSD), superior spatial dimension, and medial spatial dimension assessed by cone-beam computed tomography preoperatively, immediately after surgery, and at 1-year follow-up. COVARIATES Covariates included sex, age, and amount of mandibular advancement. ANALYSES Estimations of independent effects of primary predictors on outcome variables were made by applying generalized estimation equation models. The value of statistical significance was P < .05. RESULTS The study sample included 88 participants. The BSSO samples included 39 patients, and the BMO group included 22 patients; the control group comprised 27 subjects. The average age was 31.2 years; the majority were female (61.4%). Adjusted generalized estimation equation models yielded a significant time interaction between BSSO and spatial dimensions over time (PSD, P < .001). Key predictors of spatial dimension changes were the baseline posterior (PSD, P < .001) and the central condylar position (PSD, P < .001). CONCLUSION AND RELEVANCE This controlled study, for the first time, provides scientific evidence on the effects of surgical intervention type and baseline condylar position on spatial dimension changes in the TMJ. It shows a more favorable outcome in long-term spatial dimension changes for patients treated by a BMO procedure.
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Affiliation(s)
- Linus Christian Hupp
- Consultant, Professor, and Head, University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Verius
- Medical Physicist, University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Kolk
- Associate Professor, Professor, and Head, University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rüdiger Emshoff
- Associate Professor, University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Buch FO, Stokbro K. Accuracy and stability of the condyle position after orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2024; 52:240-245. [PMID: 38172014 DOI: 10.1016/j.jcms.2023.12.008] [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: 01/13/2022] [Revised: 06/21/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The purpose of this study was to evaluate the accuracy and stability of condylar positioning in patients treated with bimaxillary procedures compared with patients treated with maxillary procedures alone. All patients had undergone treatment at Odense University Hospital and were treated with inferior maxillary procedures. The primary outcome was changes in condyle position and the primary predictor variable was time: pre-operative (T0) measurements to 1-week post-operative (T1) and 1-year post-operative (T2) measurements. Condyle movement was measured using dual voxel-based alignment. Sixteen patients were included. Seven patients underwent solitary maxillary procedure and 9 patients bimaxillary procedure. Bimaxillary procedures overall showed a condyle positional change in pitch from T0 to T1 and T1 to T2 compared to maxillary procedures alone. Condylar translation was stable despite large differences in positioning. Compared to solitary maxillary procedures, bimaxillary procedures showed a statistically significant anterocranial rotation at 1-week follow-up movement (3.95° vs. -0.95°; SD 3,74 vs 1,05; P value = 0.000) and an additional statistically significant anterocranial movement at 1 year after surgery (4.89° vs 0.60°; SD 3,82 vs 0,92; P value = 0.000). In conclusion a need for greater anterocranial stability of the sagittal split osteotomy than that provided by 3 bicortically fixated screws alone might be indicated.
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Affiliation(s)
- Frederik Ohm Buch
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Denmark
| | - Kasper Stokbro
- Consultant Surgeon & Head of Research, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Oral and Maxillofacial Research Department, Clinical Institute, University of Southern Denmark, Denmark.
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Park C, Kim H, Ryu J, Jung S, Park HJ, Oh HK, Kook MS. Condylar volume and positional changes following a bilateral sagittal split ramus osteotomy in skeletal class II and III malocclusions. Maxillofac Plast Reconstr Surg 2023; 45:41. [PMID: 38008875 PMCID: PMC10678871 DOI: 10.1186/s40902-023-00408-3] [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: 09/25/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Mandibular condyle remodeling and displacement are post-orthognathic surgery concerns that can potentially lead to occlusal issues after bilateral sagittal split ramus osteotomy. This retrospective study examined the relationship between condylar volume changes and position alterations after surgery in patients with skeletal class II and III malocclusions using cone-beam CT. METHODS The study included 16 patients (6 with Class II malocclusion, 10 with Class III malocclusion) who underwent bilateral sagittal split ramus osteotomy at Chonnam National University Hospital. Cone-beam CT data were collected at three specific time points: before surgery, immediately after surgery, and approximately 6 months post-surgery. Mandibular movement was measured using InVivoDental 5.4.6. ITK-SNAP 3.8.0 was used to assessed condylar volume changes post-surgery. Condyle positions were evaluated in four parts with RadiAnt DICOM Viewer 4.6.9. Statistical analyses were performed using the SPSS version 23. RESULTS Considering both Class II and III malocclusion, a 2.91% volume reduction was noted immediately and at 6 months after surgery. Both Class II and III cases demonstrated a decrease in superior joint space by -0.59 mm and medial joint space by -1.09 mm. No significant correlation was found between this process and condylar volume change. CONCLUSIONS The mandibular condyle volume decreased, and superior-medial movement of the condyle was detected in patients with Class II and III malocclusion immediately and at 6 months after surgery with no volume-position correlation.
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Affiliation(s)
- Chulyoung Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hyejin Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jaeyoung Ryu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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Lekroengsin B, Tachiki C, Takaki T, Nishii Y. Relationship between Changes in Condylar Morphology and Masticatory Muscle Volume after Skeletal Class II Surgery. J Clin Med 2023; 12:4875. [PMID: 37510990 PMCID: PMC10381303 DOI: 10.3390/jcm12144875] [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: 06/26/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
The treatment of dentofacial deformities generally includes orthognathic surgery in which mandibular condyle changes following surgery are a common cause of relapse. This study investigated the changes in the mandibular condyle and related muscles to identify the factors that affected the changes in the mandibular condyle after orthognathic surgery in skeletal class II patients. This research studied 60 joints in 30 patients with skeletal class II dentofacial deformities who received surgical orthodontic treatment, including bilateral sagittal split ramus osteotomy, and underwent computed tomography before and after orthodontic treatment. The mandibular condyle, masseter, and medial pterygoid muscles were reconstructed and measured in 3D. Condylar positional and morphology changes, masseter and medial pterygoid muscle volume, temporomandibular joint (TMJ) pain, and distal segment movement were analyzed. The study observed that both the masseter and medial pterygoid muscle volumes decreased with statistical significance. The changes in the horizontal direction were positively correlated with the amount of movement. The findings indicated that mandibular condyle changes were significantly affected by the movement of the distal segment, the medial pterygoid muscle volume, and the direction of the distal segment, which influenced the treatment's long-term stability after orthognathic surgery.
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Affiliation(s)
| | - Chie Tachiki
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Takashi Takaki
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Yasushi Nishii
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan
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Hupp LC, Verius M, Bertram A, Kolk A, Emshoff R. Modeling the effect of bilateral sagittal split osteotomy on posterior, superior and medial space dimensions of the temporomandibular joint: a retrospective controlled cohort study. BMC Oral Health 2023; 23:302. [PMID: 37198590 DOI: 10.1186/s12903-023-02959-3] [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: 11/05/2022] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND To model the effect of isolated bilateral sagittal split osteotomy (BSSO) on changes in posterior (PSD), superior (SSD), and medial space dimensions (MSD) of the temporomandibular joint. METHODS Using a retrospective cohort study design, pre- and postoperative (immediately after surgery; 1 year follow-up) cone-beam computed tomography measurements of 36 patients who had undergone BSSO for mandibular advancement were compared with a control group of 25 subjects from whom a mandibular odontogenic cyst was removed under general anesthesia. Generalized estimation equation (GEE) models were used to examine the independent effects of study group, preoperative condylar position, and time points on PSD, SSD, and MSD adjusting for covariates (age, sex, and mandibular advancement). RESULTS No significant differences were found regarding changes in PSD (p = 0.144), SSD (p = 0.607), or MSD (p = 0.565) between the BSSO and control groups. However, the preoperative posterior condylar position showed significant effects on PSD (p < 0.001) and MSD (p = 0.043), while the preoperative central condylar position demonstrated a significant effect on PSD (p < 0.001). CONCLUSION The data suggest that preoperative posterior condylar position is a significant effect modifier of PSD and MSD over time in this cohort.
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Affiliation(s)
- Linus Christian Hupp
- University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Verius
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Annika Bertram
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Kolk
- University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Rüdiger Emshoff
- University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Kaur A, Rattan V, Rai S, Singh SP, Kalra P, Sharma S. Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD)- a prospective study. J Craniomaxillofac Surg 2022; 50:915-922. [PMID: 36621385 DOI: 10.1016/j.jcms.2022.12.003] [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: 04/25/2022] [Revised: 10/16/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
The aim of the study was to assess the changes in the condylar position after orthognathic surgery (OGS) and its effect on temporomandibular disorders (TMD). A total of 37 dentofacial deformity patients included in the study who had undergone OGS were divided into three groups: Group I, Le Fort I maxillary advancement; Group II, bilateral sagittal split osteotomy (BSSO) mandibular advancement ± Le Fort I; and Group III, BSSO mandibular setback ± Le Fort I. Patients were evaluated clinically using Diagnostic Criteria for TMD and by radiography preoperatively and 6 months postoperatively. The positional changes in condyle were correlated with signs and symptoms of TMD. A total of 37 patients in three groups (Group I, 8 patients; Group II, 10 patients; and Group III, 19 patients) were evaluated. Overall, condyles had anterio-medio-inferior movement with 7 of 8 patients in Group I, 6 of 10 patients in Group II and 13 of 19 patients in Group III having ≤2 mm displacement. In angular changes, inward-anterio-medial movement was observed with 6 of 8 patients in Group I; about 5 of 10 patients, and 10 of 19 patients in Group II and III respectively had ≤5° change. Intragroup and intergroup comparisons showed insignificant changes in TMD and linear/angular movement (p ≥ 0.05). Pearson correlation coefficient was found to be nonsignificant on the radiographic and clinical comparison (p ≥ 0.05). Intrarater reliability (Kappa value) was found to be 0.83, confirming the results. Within the limitations of the study it seems that there are minimal linear and angular changes in condyle after orthognathic surgery that were not responsible for the development of temporomandibular disorders in the postoperative course.
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Affiliation(s)
- Amanjot Kaur
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Vidya Rattan
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Sachin Rai
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Satinder Pal Singh
- Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Parveen Kalra
- Centre of Excellence in Industrial and Product Design, Punjab Engineering College, Chandigarh, India.
| | - Shagun Sharma
- Centre of Excellence in Industrial and Product Design, Punjab Engineering College, Chandigarh, India.
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Xie Y, Zeng R, Yan J, Yan T, Tan J. Introducing surface-to-surface matching technique to evaluate mandibular symmetry: A retrospective study. Heliyon 2022; 8:e09914. [PMID: 35855982 PMCID: PMC9287795 DOI: 10.1016/j.heliyon.2022.e09914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study introduced a three-dimensional (3D) surface-to-surface matching technique to evaluate the mandibular symmetry of teenagers and adults with unilateral second molar scissor bite. Methods The targets came from 73 cone-beam computed tomography (CBCT) images with unilateral second molar scissor bite, including teenagers (n = 30) and adults (n = 43). 73 images without scissor bite and matched in sex and age were selected as controls. The scans were developed into 3D mandible models and seven mandibular functional unit models, including condylar process (Co), coronoid process (Cr), mandibular ramus (Ra), mandibular angle (Ma), alveolar process (Ap), mandibular body (Mb) and chin process (Ch). The surface-to-surface matching technique was introduced. 3D deviation analysis and matching percentages calculation were performed and compared to evaluate the symmetry of the mandible. Results Comparisons were made between the study samples and control samples. For teenagers, the matching percentages of the entire mandible (55.31 ± 7.24%), Mb (69.04 ± 9.22%) and Co (65.19 ± 10.67%) in the study group were lower than that of the entire mandible (60.87 ± 6.38%) (P <0.01), Mb (75.0 ± 8.71%) (P <0.05) and Co (70.25 ± 8.20%) (P <0.05) in the control group. While Ap, Ra, Ch, Cr and Ma showed no statistically significant differences (P >0.05). For adults, the matching percentages of the entire mandible (48.88 ± 9.77%), Ap (65.83 ± 11.21%), Mb (64.43 ± 12.03%), Ch (79.17 ± 10.29%), Ra (64.11 ± 9.84%) and Co (61.08 ± 11.64%) in the study group were lower than the entire mandible (59.28 ± 5.49%) (P <0.01), Ap (73.65 ± 9.10%) (P <0.01), Mb (71.66 ± 8.40%) (P <0.01), Ch (83.86 ± 5.59%) (P <0.05), Ra (68.54 ± 7.87%) (P <0.05) and Co (66.20 ± 10.62%) (P <0.05) of the control group. Only Cr and Ma showed no statistically significant differences (P >0.05). Conclusion Mandibular asymmetry was observed in both teenagers and adults with unilateral second molar scissor bite. Moreover, compared with teenagers, more mandibular units of adult patients were affected. Clinical significance Based on the surface-to-surface matching technique, the symmetric and morphological information of the mandible can be converted into visual color maps and quantitative descriptions. This method can bring convenience to the study of the growth of mandible, orthodontic treatment and orthognathic surgery design.
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Affiliation(s)
- Yajuan Xie
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Runling Zeng
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Jiayin Yan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Tong Yan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
| | - Jiali Tan
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510080, China
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Shao B, Li A, Shu J, Ma H, Dong S, Liu Z. Three-dimensional morphological and biomechanical analysis of temporomandibular joint in mandibular and bi-maxillary osteotomies. Comput Methods Biomech Biomed Engin 2021; 25:1393-1401. [PMID: 34898353 DOI: 10.1080/10255842.2021.2014822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Orthognathic surgery is a typical approach for treating maxillofacial deformities. However, orthognathic surgery results in positional changes in the condyles. In a previous review, the effects of orthognathic surgery on temporomandibular joints (TMJs) are not provided. Hence, in this study, we investigate the morphological changes in TMJs after mandibular and bi-maxillary osteotomies. The relationship between the morphological parameters of TMJs and symptoms of temporomandibular disorders (TMDs) is discussed. Finite element contact stress analysis is performed, and the results show that the two abovementioned surgeries can improve maxillofacial deformities, although the positions of the condyles are changed. Moreover, preoperative stress asymmetry of the left and right TMJs is observed, which remain after the surgeries. TMD patient-specific analysis shows that three joint spaces (medial joint space, lateral joint space, superior joint space) are significantly correlated with TMD symptoms.
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Affiliation(s)
- Bingmei Shao
- Basic Mechanics Lab of Sichuan University, Sichuan University, Chengdu, China.,Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China
| | - Annan Li
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China.,Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Jingheng Shu
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China.,Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Hedi Ma
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China.,Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
| | - Shiming Dong
- Department of Mechanics & Engineering, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Zhan Liu
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China.,Key Laboratory of Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
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9
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Van den Borre C, Van de Casteele E, Boeckx P, Nadjmi N. A novel instrument for the prevention of condylar torque in bilateral sagittal ramus osteotomy when using bicortical screw fixation. Int J Oral Maxillofac Surg 2021; 51:376-379. [PMID: 34325976 DOI: 10.1016/j.ijom.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022]
Abstract
When using the bilateral sagittal split osteotomy (BSSO) technique, rigid internal fixation (RIF) remains the standard method to accurately fix the distal and proximal osteotomy fragments. A concern with the use of RIF, especially with bicortical screws, is the increased risk of condylar torque and its functional consequences. This technical note introduces a new method for preventing torque of the mandibular condyles after BSSO, using a sagittal split space maintainer.
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Affiliation(s)
- C Van den Borre
- Department of Cranio-Maxillofacial Surgery, ZMACK, AZ Monica Antwerpen, Antwerp, Belgium
| | - E Van de Casteele
- All for Research vzw, Antwerp, Belgium; Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
| | - P Boeckx
- Department of Cranio-Maxillofacial Surgery, ZMACK, AZ Monica Antwerpen, Antwerp, Belgium
| | - N Nadjmi
- Department of Cranio-Maxillofacial Surgery, ZMACK, AZ Monica Antwerpen, Antwerp, Belgium; All for Research vzw, Antwerp, Belgium; Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium.
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10
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Johner JP, Essig H, Neff A, Wagner MEH, Blumer M, Gander T. Volumetric Evaluated Bone Resorption After Open Reduction and Internal Fixation of Condylar Head Fractures of the Mandible. J Oral Maxillofac Surg 2021; 79:1902-1913. [PMID: 34062130 DOI: 10.1016/j.joms.2021.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Decision making in the management of condylar head fractures remains difficult due to its dependency on multiple factors like fracture type, degree of dislocation, patient`s age and dental condition. As open reduction and internal fixation (ORIF) of condylar head fractures (CHFs) becomes more popular, the question of osteosynthesis removal is controversial. So far, information on volumetric changes after ORIF are available for a short-term period (<6 months) only. This study, therefore, was performed to assess bone resorption after condylar head fractures and to follow-up intermediate-term (>1 year) remodelling after removal of metallic osteosynthesis material. Furthermore clinical outcome was measured using Helkimo Index and put in relation with bone resorption. MATERIALS AND METHODS A retrospective analysis of 19 patients who underwent open reduction and internal fixation of condylar head fractures at the University Hospital of Zürich between January 2016 and April 2018 using intraoperative cone-beam computed tomography repositioning control was conducted. The bone resorption on the condylar head was measured in the course after removal of osteosynthesis material by segmenting and superimposing of the postoperative 3D radiologic follow-up exam (T2) over the initial intraoperative cone-beam computed tomography (T1) using iPlan-CMF software. Complementary Helkimo index was assessed to put resorption rate in relation to clinical outcome. RESULTS A total of 19 patients fulfilled the inclusion criteria. The mean follow-up time was 15.6 months and the mean bone resorption on the condylar head was -0.348cm3 or -15.29% of segmented condylar head. There was no correlation of clinical outcome and bone resorption. CONCLUSIONS Helkimo index showed satisfying results; therefore, ORIF of condylar head fracture proves as a feasible treatment option. The mean bone resorption rate of -15.29% in the intermediate-term follow-up time (mean 15.6 months) is comparable to findings of other studies with short-term follow-up time (< 6 months). Thus, postinterventional remodeling activity and resorption seems highest in the first 4 to 6 postoperative months with little further resorption. In prevention of negative sequelae of protruding implants, timing of osteosynthesis material removal after this period of high bone remodeling activity is recommended. The resorption rate showed no correlation to clinical outcome.
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Affiliation(s)
- Jean-Pierre Johner
- Resident, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland.
| | - Harald Essig
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Andreas Neff
- Professor, Department of Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Germany
| | - Maximilian E H Wagner
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Michael Blumer
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Thomas Gander
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
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Lee JY, Lee SM, Kim SH, Kim YI. Long-term follow-up of intersegmental displacement after orthognathic surgery using cone-beam computed tomographic superimposition. Angle Orthod 2021; 90:548-555. [PMID: 33378504 DOI: 10.2319/061119-398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate intersegmental displacement during long-term follow-up after bilateral sagittal split osteotomy (BSSO) by mandibular body area superimposition. MATERIALS AND METHODS Cone-beam computed tomography (CBCT) images of 23 patients ages 18-37 years with class III malocclusion before orthognathic surgery were obtained. A three-dimensional (3D) CBCT examination was performed at four stages: surgery (T0), 6 months after surgery (T1), 1 year after surgery (T2), and long-term follow-up (6.1 ± 2.1 years, T3). The CBCT datasets were superimposed on the symphyseal area and the lower part of the distal segment of the mandible between T0 and the other time points (T1, T2, and T3). The reference points (both condyle, coronoid, and sigmoid) were estimated by the CBCT analyzed program. RESULTS The coronoid, condylion, and sigmoid showed changes within 6 months after surgery, but there was no significant change in the intersegmental displacement between 6 months and 6 years after surgery. The distances between the left and right coronoid, condylion, and sigmoid from T0 to T3 were noted. CONCLUSIONS The change in intersegmental displacement between T0 and T3 affecting relapse after orthognathic surgery was not significantly different. This suggests that the mandible itself may have a stable morphology during the follow-up period.
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Kim SR, Jang S, Ahn KM, Lee JH. Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap. MATERIALS 2020; 13:ma13102333. [PMID: 32438671 PMCID: PMC7287575 DOI: 10.3390/ma13102333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
In the present study, the reproducibility and postoperative stability of a 3D printed surgical guide were evaluated in mandibular reconstruction with an osteocutaneous free flap (OCFF), including a fibular free flap (FFF) and deep circumflex iliac artery free flap (DCIA). Fifteen patients were enrolled, and a 3D surgical guide was fabricated by simulation surgery using preoperative (T0) Computed tomography (CT) images. Mandibular reconstruction was performed with OCFF using the 3D surgical guide. Postoperative CTs were taken immediately, 1 week (T1), and 6 months (T2) after surgery, to evaluate the reproducibility of the 3D surgical guide and condyle stability. Error of the 3D surgical guide ranged from 0.85 to 2.56 mm. There were no differences in reproducibility according to flap type. Condylar error and error at mandible midpoint were significantly different in FFF. However, there was no difference in DCIA error between the condyle and mandible midpoint. Regarding condyle stability 6 months after surgery, condyles moved more than 2 mm (up to 2.85 mm) in FFF, whereas there were no significant movement in DCIA. Careful intraoperative flap fixation and closed postoperative observation should be considered for stable clinical outcome, especially in the case of FFF.
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Affiliation(s)
- Seong Ryoung Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, ASAN MEDICAL CENTER, Seoul 05505, Korea; (S.R.K.); (K.-M.A.)
| | - Sam Jang
- Coreline Soft, Seoul 03991, Korea;
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, ASAN MEDICAL CENTER, Seoul 05505, Korea; (S.R.K.); (K.-M.A.)
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, ASAN MEDICAL CENTER, Seoul 05505, Korea; (S.R.K.); (K.-M.A.)
- Correspondence: or ; Tel.: +82-2-3010-1757
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Wan Y, Jackson T, Chung C, Gao F, Blakey G, Nguyen T. Comparison of condylar position in orthognathic surgery cases treated with virtual surgical planning vs. conventional model planning. Orthod Craniofac Res 2019; 22 Suppl 1:142-148. [PMID: 31074137 DOI: 10.1111/ocr.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of virtual surgical planning (VSP) on the accuracy of condylar seating in surgical cases involving Bilateral Sagittal Split Osteotomy (BSSO). An additional aim was to quantify differences between actual surgical outcome and planned virtual outcome. SETTING AND SAMPLE POPULATION A private practice in Charlotte North Carolina. Twenty-five consecutively operated subjects prepared with VSP and twenty consecutively subjects operated with conventional surgery planning were enrolled. MATERIAL AND METHODS Cone beam computed tomography (CBCT) scans were obtained before surgery (T1) and post-surgery after splint removal (T2). The T1 and T2 CBCTs were superimposed on the anterior cranial base using voxel-based registration. Three dimensional (3D) models were built and oriented to a 3D Frankfurt horizontal. Displacement of corresponding condylar landmarks was measured. RESULTS No significant difference was found between the VSP and conventional group in the magnitude of translation or rotation of the condyles following surgery. VSP surgical outcomes differed significantly from predicted positions at all landmarks. Virtual surgical planning does not prevent changes to condylar position as a result of surgery. Actual surgical results differed significantly from VSP-predicted outcomes. CONCLUSIONS Virtual surgical planning did not reduce the changes to condylar position and angulation that resulted from conventionally planned orthognathic surgery.
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Affiliation(s)
- Ying Wan
- Department of Orthodontics, The University of North Carolina, Chapel Hill, North Carolina
| | - Tate Jackson
- Department of Orthodontics, The University of North Carolina, Chapel Hill, North Carolina
| | - Chooryung Chung
- Department of Orthodontics, The University of North Carolina, Chapel Hill, North Carolina
| | - Fei Gao
- Department of Orthodontics, The University of North Carolina, Chapel Hill, North Carolina
| | - George Blakey
- Department of Orthodontics, The University of North Carolina, Chapel Hill, North Carolina
| | - Tung Nguyen
- Department of Orthodontics, The University of North Carolina, Chapel Hill, North Carolina
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Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography. Clin Oral Investig 2019; 24:2663-2672. [DOI: 10.1007/s00784-019-03128-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
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Lee CH, Cho SW, Kim JW, Ahn HJ, Kim YH, Yang BE. Three-dimensional assessment of condylar position following orthognathic surgery using the centric relation bite and the ramal reference line: A retrospective clinical study. Medicine (Baltimore) 2019; 98:e14931. [PMID: 30896656 PMCID: PMC6709179 DOI: 10.1097/md.0000000000014931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Orthognathic surgery (OGS) is a relatively common procedure for solving functional and aesthetic problems in facial and jaw areas in patients with dentofacial deformities. The positioning of the mandibular condylar segment during OGS has an impact on the surgical outcome. This study aimed to investigate the changes in the condyle-fossa relationship three dimensionally after OGS using the centric relation (CR) bite and the ramal reference line (RRL).Thirty-two patients with skeletal malocclusion underwent OGS. Condylar repositioning was performed using the CR bite, as previously reported. A RRL was added to the existing method and used during the surgery. Cone-beam computed tomography scans were acquired at 4 time points. Sixty-four condyles were evaluated in the coronal, sagittal, and axial views. Two groups were created according to the amount of mandible setback (SB1 vs SB2), and another 2 groups were created according to the maxillary operation (1-jaw vs 2-jaw). Each was then compared at the 4 time points. Differences between the values before (T0) and a year after surgery (T3) were also investigated. The positions of the pogonion and the menton were examined at T2 and T3 for the simple evaluation of relapse.The change in the condylar position was significant over a time-course (P < .001) but not between T0 and T3 (P > .05). Neither the setback amount nor the maxillary operation affected the positional change (P > .05). There were no significant changes between T2 and T3 in the relapse evaluation.This condylar repositioning method using the CR bite and a RRL showed stable results after OGS. This method is noninvasive and cost-effective and can be easily performed even by an inexperienced surgeon because it reduces errors in repositioning the condyle during OGS.
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Affiliation(s)
- Chang-Hyeon Lee
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
| | - Seoung-Won Cho
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
| | - Ju-Won Kim
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
| | - Hyo-Jung Ahn
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
- Department of Orthodontics
| | - Young-Hee Kim
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
- Department of Image Science in Dentistry, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
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Wang W, Shan XF, Liang J, Xie S, Zhang J, Cai ZG. Changes in Condylar Position After Mandibular Reconstruction With Condylar Head Preservation by Computed Tomography. J Oral Maxillofac Surg 2019; 77:1286-1292. [PMID: 30735641 DOI: 10.1016/j.joms.2018.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/18/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022]
Abstract
PURPOSE Condylar position can change after mandibular reconstruction using the free fibula flap. The present study evaluated changes in condylar position using computed tomography (CT) after mandibular reconstruction with condylar head preservation. MATERIALS AND METHODS This retrospective study consisted of 16 patients. CT data of 32 temporomandibular joints (TMJs) were recorded before surgery (T0), 7 to 10 days after surgery (T1), and 16.8 ± 7.4 months after surgery (T2). The anteroposterior condylar position was evaluated using the method of Pullinger and Hollender (Oral Surg Oral Med Oral Pathol 62:719, 1986). Repeated-measures analysis of variance (P = .05) was performed. RESULTS Data of 16 patients were obtained for statistical analysis. Condylar position changed over time after mandibular reconstruction. The ipsilateral condyles moved anteroinferiorly after surgery (T0 to T1) and tended to move anterosuperiorly during follow-up (T1 to T2). No major changes were noted in the contralateral condyles. CONCLUSION Condylar positions showed obvious changes over time after mandibular reconstruction with condylar preservation. Nevertheless, additional studies are warranted to further evaluate the relation between condylar position and TMJ function.
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Affiliation(s)
- Wei Wang
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing; Beijing Key Laboratory of Digital Stomatology, Beijing; National Clinical Research Center for Oral Diseases, Beijing, China
| | - Xiao-Feng Shan
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing; Beijing Key Laboratory of Digital Stomatology, Beijing; National Clinical Research Center for Oral Diseases, Beijing, China
| | - Jie Liang
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing; Beijing Key Laboratory of Digital Stomatology, Beijing; National Clinical Research Center for Oral Diseases, Beijing, China
| | - Shang Xie
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing; Beijing Key Laboratory of Digital Stomatology, Beijing; National Clinical Research Center for Oral Diseases, Beijing, China
| | - Jie Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing; Beijing Key Laboratory of Digital Stomatology, Beijing; National Clinical Research Center for Oral Diseases, Beijing, China
| | - Zhi-Gang Cai
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School & Hospital of Stomatology, Beijing; National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing; Beijing Key Laboratory of Digital Stomatology, Beijing; National Clinical Research Center for Oral Diseases, Beijing, China.
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da Silva R, Valadares Souza C, Souza G, Ambrosano G, Freitas D, Sant’Ana E, de Oliveira-Santos C. Changes in condylar volume and joint spaces after orthognathic surgery. Int J Oral Maxillofac Surg 2018; 47:511-517. [DOI: 10.1016/j.ijom.2017.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/01/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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Ueki K, Moroi A, Tsutsui T, Hiraide R, Takayama A, Saito Y, Sato M, Baba N, Tsunoda T, Hotta A, Yoshizawa K. Time-course change in temporomandibular joint space after advancement and setback mandibular osteotomy with Le Fort I osteotomy. J Craniomaxillofac Surg 2018; 46:679-687. [DOI: 10.1016/j.jcms.2018.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/28/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022] Open
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Kim YK. Complications associated with orthognathic surgery. J Korean Assoc Oral Maxillofac Surg 2017; 43:3-15. [PMID: 28280704 PMCID: PMC5342970 DOI: 10.5125/jkaoms.2017.43.1.3] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022] Open
Abstract
While most patients undergo orthognathic surgery for aesthetic purposes, aesthetic improvements are most often followed by postoperative functional complications. Therefore, patients must carefully decide whether their purpose of undergoing orthognathic surgery lies on the aesthetic side or the functional side. There is a wide variety of complications associated with orthognathic surgery. There should be a clear distinction between malpractice and complications. Complications can be resolved without any serious problems if the cause is detected early and adequate treatment provided. Oral and maxillofacial surgeons must have a full understanding of the types, causes, and treatment of complications, and should deliver this information to patients who develop these complications.
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Affiliation(s)
- Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
INTRODUCTION Since the beginning of cephalometric analysis, a significant number of approaches to vertical facial proportions have been proposed. In our view, diagnosing a vertical problem has nothing to do with numbers or measurements. It's all about perceptions and - rather subjective - impressions. An "impression" of long face may be provoked by the following causes isolated or combined: vertical maxillary hyperplasia, open bite, anterior vertical mandibular hyperplasia, narrow face, lack of chin-neck definition. METHOD Clinical planning in these cases is followed by 3D simulation and CAD/CAM generation of surgical splints. CONCLUSION Surgical management of the Long Face Syndrome may include the following strategies isolated or combined : maxillary impaction, vertical chin reduction, counterclockwise rotation of the occlusal plane.
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