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Podcernina J, Jakobsone G, Urtane I, Salms G, Radzins O. Long-term evaluation of condylar positional and volumetric parameters and skeletal stability in Class III bimaxillary orthognathic surgery patients. Int J Oral Maxillofac Surg 2024; 53:707-714. [PMID: 38383213 DOI: 10.1016/j.ijom.2024.01.013] [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: 08/17/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
This retrospective study examined long-term (4-5 years) condylar positional and volumetric changes and skeletal stability after bimaxillary orthognathic surgery in skeletal Class III patients. Pre-surgical (T0: 0.9 ± 1.1 months) and post-surgical (T1: 0.6 ± 0.7 months; T2: 12.8 ± 3.1 months; T3: 56.5 ± 6.5 months) cone beam computed tomography (CBCT) images of 22 patients were obtained. CBCT multiplanar reformation (MPR) images were generated, and three-dimensional (3D) condylar models were constructed and superimposed to compare changes in condylar volume from pre- to postoperative. Condylar position in the sagittal and coronal planes altered immediately after surgery; however at long-term follow-up, the condyles had returned to their pre-surgical position. The condyles remained slightly inwardly rotated at short-term (-2.6°, 95% confidence interval -3.5° to -1.7°) and long-term (-1.9°, 95% confidence interval -2.8° to -1.0°) follow-up. Changes in condylar volume were insignificant after surgery. Condylar positional changes had no effect on skeletal stability. However, patients with an increased face height prior to surgery and more retrusive jaw position postoperatively were more prone to condylar resorption. Surgical changes remained stable 4-5 years after surgery. In conclusion, condylar position changed insignificantly following surgical correction in Class III patients provided that the correct surgical technique was employed.
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Affiliation(s)
- J Podcernina
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia.
| | - G Jakobsone
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
| | - I Urtane
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
| | - G Salms
- Department of Oral and Maxillofacial Surgery, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
| | - O Radzins
- Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia
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Shi J, Lin G, Bao R, Zhang Z, Tang J, Chen W, Chen H, Zuo X, Feng Q, Liu S. An automated method for assessing condyle head changes in patients with skeletal class II malocclusion based on Cone-beam CT images. Dentomaxillofac Radiol 2024; 53:325-335. [PMID: 38696751 PMCID: PMC11211682 DOI: 10.1093/dmfr/twae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/01/2024] [Accepted: 04/06/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES Currently, there is no reliable automated measurement method to study the changes in the condylar process after orthognathic surgery. Therefore, this study proposes an automated method to measure condylar changes in patients with skeletal class II malocclusion following surgical-orthodontic treatment. METHODS Cone-beam CT (CBCT) scans from 48 patients were segmented using the nnU-Net network for automated maxillary and mandibular delineation. Regions unaffected by orthognathic surgery were selectively cropped. Automated registration yielded condylar displacement and volume calculations, each repeated three times for precision. Logistic regression and linear regression were used to analyse the correlation between condylar position changes at different time points. RESULTS The Dice score for the automated segmentation of the condyle was 0.971. The intraclass correlation coefficients (ICCs) for all repeated measurements ranged from 0.93 to 1.00. The results of the automated measurement showed that 83.33% of patients exhibited condylar resorption occurring six months or more after surgery. Logistic regression and linear regression indicated a positive correlation between counterclockwise rotation in the pitch plane and condylar resorption (P < .01). And a positive correlation between the rotational angles in both three planes and changes in the condylar volume at six months after surgery (P ≤ .04). CONCLUSIONS This study's automated method for measuring condylar changes shows excellent repeatability. Skeletal class II malocclusion patients may experience condylar resorption after bimaxillary orthognathic surgery, and this is correlated with counterclockwise rotation in the sagittal plane. ADVANCES IN KNOWLEDGE This study proposes an innovative multi-step registration method based on CBCT, and establishes an automated approach for quantitatively measuring condyle changes post-orthognathic surgery. This method opens up new possibilities for studying condylar morphology.
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Affiliation(s)
- Jiayu Shi
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Guoye Lin
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, 510515, China
| | - Rui Bao
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Zhen Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Jin Tang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Wenyue Chen
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Hongjin Chen
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Xinwei Zuo
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, 510515, China
| | - Shuguang Liu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510261, China
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Dvoranova B, Vavro M, Czako L, Hirjak D. Does orthognathic surgery affect mandibular condyle position? A retrospective study. Oral Maxillofac Surg 2024; 28:639-643. [PMID: 37740127 PMCID: PMC11144676 DOI: 10.1007/s10006-023-01181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE The aim of this study is to analyze mandibular condyle position changes after bilateral sagittal split osteotomy (BSSO) and bimaxillary orthognathic surgery in patients operated at a single department by two surgeons in 2013-2022. Compared were groups of mandibular advancement vs setback and bimaxillary vs BSSO. METHODS Ninety-nine subjects were included. Inclusion criteria were patients who underwent one of the BSSO or bimaxillary surgery and had CT scans performed before and after surgery. Preoperative CT scans were performed 1 day before surgery and postoperative CT scans 6-12 months afterwards. Changes in mandibular condyle position were measured in axial and sagittal planes. RESULTS CT condylar position measurements indicated significant postoperative changes in AB angle bilaterally (p = < 0.001). In mandibular advancement and setback comparison, values were significantly lower in ABL angle values in the setback group (p = 0.011326) and significantly higher in FDR in the advancement group (p = 0.005795). There were no statistically significant changes found in BSSO and bimaxillary group comparison. CONCLUSION Within the limitations of this study, it can be concluded that orthognathic surgery does have a moderate effect on position of the condyles, especially condylar rotation in transversal axis.
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Affiliation(s)
- Bronislava Dvoranova
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia.
| | - Michal Vavro
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Ladislav Czako
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University and University Hospital Bratislava, Bratislava, Slovakia
| | - Dusan Hirjak
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University, Oncologic Institute of St Elisabeth, Bratislava, Slovakia
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Holte MB, Nielsen TW, Cattaneo PM, Pinholt EM. Stability of proximal mandibular anatomical structures following bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00100-0. [PMID: 38702201 DOI: 10.1016/j.ijom.2024.04.006] [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: 09/05/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
The aim of this study was to investigate the stability of the proximal mandibular reference structures that have been proposed in the literature for superimposition. Forty proximal mandibular segments of 20 patients who underwent bilateral sagittal split osteotomy (BSSO) for advancement were reconstructed from a pair of pre- and postoperative (2 years) cone beam computed tomography scans, and spatially divided into the mandibular condyle, the coronoid process, and 20 mandibular ramus regions. To assess the stability of the anatomical regions, the volumetric and surface discrepancy between the superimposed pre- and postoperative regions were calculated. One-sample t-tests were applied to analyse the statistical stability of the individual regions. Two statistically stable (P < 0.05) structures in the proximal segment of the mandible following BSSO were identified: (1) the posterior part of the mandibular ramus above the gonial angle and below the condylar neck, and (2) the sub-coronoid area below the coronoid process/mandibular notch. Using these stable structures for superimposition resulted in an assessment discrepancy in the condylar displacement of up to 1.1 mm and in the volumetric change of up to 2.8%. Hence, it is suggested that these two identified stable structures are used as reference areas when assessing condylar displacement and change using superimposition.
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Affiliation(s)
- M B Holte
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark
| | - T W Nielsen
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark
| | - P M Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - E M Pinholt
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Esbjerg, Denmark.
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Eduardo Charles Pagotto L, Freitas de Morais E, de Santana Santos T, Pires Pastore G. Evaluating changes in the condylar head after orthognathic surgery with or without articular disc repositioning: a systematic review. Br J Oral Maxillofac Surg 2024; 62:340-348. [PMID: 38521741 DOI: 10.1016/j.bjoms.2024.01.004] [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: 06/27/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 03/25/2024]
Abstract
Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.
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Affiliation(s)
| | | | | | - Gabriel Pires Pastore
- Instituto de Ensino e Pesquisa do Hospital Sírio-Libanês (IEP), São Paulo (SP), Brazil.
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Gao H, Bi D, Al-Watary MQH, Song L, Sun X, Zhao Q, Li J. Morphological Changes of the Mandibular Angle After Orthognathic Surgery with Class III Deformity in East Asia. Aesthetic Plast Surg 2024; 48:816-826. [PMID: 37758853 DOI: 10.1007/s00266-023-03658-8] [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: 07/10/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
The aims of this study were to analyze the morphological changes of the mandibular angle after orthognathic surgery for mandibular setback and investigate related factors. This retrospective study included patients from January 2017 to December 2021 diagnosed with skeletal class III deformity who underwent BSSRO (Group I) or bimaxillary surgery (Group II). Preoperative (T0), within 1 month postoperatively (T1), and 6 months postoperatively (T2) CT scans were collected from 61 patients to three-dimensionally analyze the proximal segment displacement, the linear and angular changes of the mandibular angle. The gonion points moved posteriorly and laterally (P < 0.001), while the inferior movement was not significant (P = 1.000, P = 0.274). The intergonial width increased by 3.32 ± 1.87 mm and 2.34 ± 1.77 mm as revealed by T2 CTs, respectively, in Group I and Group II. Mandibular angle decreased in both groups and by 1.41 ± 2.95° in Group I and 1.37 ± 3.41° in Group II. The increase in intergonial width between T1 and T0 was negatively correlated with the preoperative mandibular angle (P = 0.003) and positively correlated with the transverse outward movement of the proximal segment (P < 0.001). After surgery, the intergonial width increased and the inferior and posterior border of the proximal segment flared outward. The changes in intergonial width and mandibular angle were mainly related to the rotation of the proximal segment, which has a certain impact on the aesthetics of the lower face. Therefore, controlling the position of the proximal segment is of vital importance to lessen the changes in the mandibular angle area.Level of Evidence III. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Heyou Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - DanDan Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mohammed Qasem Hezam Al-Watary
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Libin Song
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoshuang Sun
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qing Zhao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthognathic and TMJ Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jihua Li
- West China College of Stomatology Sichuan University, Chengdu, 610041, China.
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Glovsky TE, Iwasaki LR, Wu Y, Liu H, Liu Y, Sousa Melo SL, Nickel JC. Orthognathic surgery effects on temporomandibular joint compressive stresses. Orthod Craniofac Res 2023; 26 Suppl 1:142-150. [PMID: 37000157 DOI: 10.1111/ocr.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION This study tested orthognathic surgery effects on temporomandibular joint (TMJ) compressive stresses. METHODS Pre- (T1) and post-surgery (T2) cone-beam computed tomography images were collected from consenting subjects aged ≥15 years. Anatomical data were used to measure surgical changes in anteroposterior mandibular position and occlusal plane angle (FH-OP), estimate condylar loading areas (mm2 ) and calculate T1 and T2 TMJ and jaw muscle forces (N) during canine biting via numerical modelling. Analysis of covariance tested for sex and biting angle differences in T2 - T1 TMJ compressive stresses (TMJ force/loading area, MPa). Principal component analyses identified jaw muscle forces that accounted for changes in T2 - T1 TMJ loads. Regression analyses tested the correlations between surgical changes in mandibular position, FH-OP, TMJ loads and muscle forces. RESULTS Of 148 cases screened, 28 females and 16 males provided complete records. Condylar loading areas were significantly smaller (P = .024) for females vs males (124 ± 5 vs 144 ± 7 mm2 ). T2 - T1 differences in TMJ compressive stresses varied by surgical change, biting angle and sex. Overall, the largest increases in TMJ compressive stresses post-surgery were for females with mandibular setbacks where FH-OP angle decreased. T2 - T1 changes in jaw muscle forces had moderate (ipsilateral, λ = 4.59; η2 = 0.071) to large (contralateral, λ = 1.49; η2 = 0.31) effects on TMJ loads. CONCLUSIONS T2 - T1 differences in TMJ compressive stresses during canine biting were affected by surgical changes in mandibular position and occlusal plane angle, biting angle and sex. Surgical changes altered jaw muscle forces for the same biting conditions and, thus, affected TMJ loads and compressive stresses.
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Affiliation(s)
- Taylor E Glovsky
- School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Laura R Iwasaki
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Ying Wu
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Hongzeng Liu
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, 37614, USA
| | - Saulo L Sousa Melo
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
| | - Jeffrey C Nickel
- Department of Oral and Craniofacial Sciences, School of Dentistry, Oregon Health and Science University, 97201, Oregon, Portland, 2730 S Moody Ave., USA
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Shu KY, Liu W, Zhao JL, Zhang ZY, Shan BG, Li XY, Ma LK. Condylar resorption post mandibular distraction osteogenesis in craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2023; 51:675-681. [PMID: 37852887 DOI: 10.1016/j.jcms.2023.10.001] [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: 03/28/2022] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
The aim of this study was to investigate the characteristics of condylar resorption in craniofacial microsomia (CFM) patients following mandibular distraction osteogenesis (MDO). Patients with unilateral type-IIa and type-IIb CFM, who had completed MDO and mandibular distractor extraction (MDE), were recruited. The height and volume of the condyle were measured on three-dimension models created by the analysis of computed tomography (CT) data. Normality analysis was performed using the Shapiro-Wilk test. Data for the affected and unaffected sides were compared using the paired t-test or Wilcoxon signed-rank test. Data for both type-IIa and type-IIb CFM were compared using the independent-samples t-test or Mann-Whitney U test. The Pearson or Spearman correlation was used to determine the correlations of condylar resorption rate with related measurements. In total, 48 type-IIa and 48 type-IIb CFM patients were included. The condylar resorption rate in type-IIa CFM (0.35 ± 0.32) was significantly associated with the height of the condyle (r = 0.776, p < 0.001) and distraction distance (r = 0.447, p = 0.001), while the condylar resorption rate in type-IIb CFM (0.49 ± 0.46) was significantly associated with the height of the condyle (r = 0.924, p < 0.001). However, there was no significant difference in condylar resorption rate between type-IIa and type-IIb CFM (p = 0.075). In addition to occlusal changes, no other negative symptoms of the TMJ were observed with condylar resorption. Condylar resorption was evident in CFM patients following mandibular distraction osteogenesis, and the condylar resorption rate showed a relationship with distraction distance and condylar height.
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Affiliation(s)
- Kai-Yi Shu
- Department of Medical Cosmetology and Plastic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Wei Liu
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiu-Li Zhao
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Yong Zhang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ba-Ga Shan
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Yuan Li
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lun-Kun Ma
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jiang Y, Yang Z, Qi Y, Peng J, Li Z, Liu X, Yi B, Wang X, Chen G, Han B, Xu T, Jiang R. Early and 1-year postsurgical stability and its factors in patients with complicated skeletal Class Ⅲ malocclusion treated by conventional and surgery-first approach: A prospective cohort study. Am J Orthod Dentofacial Orthop 2023; 164:728-740. [PMID: 37516951 DOI: 10.1016/j.ajodo.2023.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION This study aimed to compare postsurgical stability between conventional (CSA) and surgery-first (SFA) approaches and investigate its prognostic factors in patients with a skeletal Class Ⅲ extraction. METHODS Twenty and 19 patients treated with LeFort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) with premolar extraction were enrolled in SFA and CSA groups, respectively. Serial cone-beam computed tomography images obtained before surgery, immediately after surgery (T1), 3 months after surgery, and 12 months after surgery were used for 3-dimensional quantitative analysis. The condyle was segmented for analyzing volumetric changes. Repeated measures analysis of variance, independent t test, and chi-square test were used to compare time-course and intergroup differences. Pearson and Kendall correlation and multivariate linear regression analyses were used to explore prognostic factors affecting skeletal stability. RESULTS In both CSA and SFA, postsurgical relapse mainly occurred in the mandible sagittal and vertical dimensions and during the first 3 months after surgery. Stability in SFA was significantly less than that in CSA. Intraoperatively, inferolateral condylar displacement with proximal segment inwards, clockwise rotation, and return movements after surgery were observed regardless of the treatment approach. The condylar volume remained stable over time. Multivariate regression analysis showed that posterior vertical dimension (VD) at T1 (-1.63 mm), surgical amount of mandibular setback (-10.33 mm), surgical condylar downwards displacement (-1.28 mm), and anterior overjet at T1 (6.43 mm) were the most important predictors of early mandibular relapse (r2 = 0.593). CONCLUSIONS The risk of early relapse could be reduced by controlling the anterior, middle, and posterior constraints provided by the prediction model.
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Affiliation(s)
- Yiran Jiang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhongpeng Yang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuhan Qi
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jiale Peng
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zili Li
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaojing Liu
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Biao Yi
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoxia Wang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gui Chen
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tianmin Xu
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
| | - Ruoping Jiang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
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Xi T, Vinayahalingam S, Bergé S, Maal T, Kwon TG. Skeletal structure of asymmetric mandibular prognathism and retrognathism. Maxillofac Plast Reconstr Surg 2023; 45:27. [PMID: 37556073 PMCID: PMC10412507 DOI: 10.1186/s40902-023-00393-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND This study aimed to compare the skeletal structures between mandibular prognathism and retrognathism among patients with facial asymmetry. RESULTS Patients who had mandibular asymmetry with retrognathism (Group A) in The Netherlands were compared with those with deviated mandibular prognathism (Group B) in Korea. All the data were obtained from 3D-reformatted cone-beam computed tomography images from each institute. The right and left condylar heads were located more posteriorly, inferiorly, and medially in Group B than in Group A. The deviated side of Group A and the contralateral side of Group B showed similar condylar width and height, ramus-proper height, and ramus height. Interestingly, there were no inter-group differences in the ramus-proper heights. Asymmetric mandibular body length was the most significantly correlated with chin asymmetry in retrognathic asymmetry patients whereas asymmetric elongation of condylar process was the most important factor for chin asymmetry in deviated mandibular prognathism. CONCLUSION Considering the 3D positional difference of gonion and large individual variations of frontal ramal inclination, significant structural deformation in deviated mandibular prognathism need to be considered in asymmetric prognathism patients. Therefore, Individually planned surgical procedures that also correct the malpositioning of the mandibular ramus are recommended especially in patients with asymmetric prognathism.
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Affiliation(s)
- Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Thomas Maal
- 3D Imaging Lab, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940 Republic of Korea
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11
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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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12
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Schiavoni R, Pacella B, Grenga C, Contrafatto R, Grenga V. Condylar remodelling in a severe class II deep bite dento-skeletal malocclusion treated with an ortho-surgical approach: A five-year follow-up case report. Int Orthod 2023; 21:100749. [PMID: 36996531 DOI: 10.1016/j.ortho.2023.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023]
Abstract
Condylar displacement and remodelling are phenomena closely related to orthognathic surgery and critically involved in occlusal and skeletal stability. The aim of the present case report is to describe over time condylar displacement and surface remodelling after bilateral split sagittal osteotomy (BSSO) in an adult patient with severe class II skeletal malocclusion treated with ortho-surgical approach. A male of 21years comes to our observation. The extraoral examination shows a symmetrical square-shaped face, a convex profile, an acute nasolabial angle and a deep labiomental fold. Intraoral examination reveals a class II division 2 with a 2mm deviation of the mandibular midline to the left and the presence of a scissor bite of the bicuspids between quadrants II and III. The Spee curve and overbite are extremely accentuated (OV 14.3mm) as the overjet (11.1mm). Axiographic reconstructions of CBCT show a normal shape and position of both condyles. The cephalometric analysis shows a reduced lower facial height, a normal upper jaw position, a mandibular underdevelopment masked by a very developed symphysis and an extremely low divergence (FMA 11.2°). BSSO for mandibular setback was performed in the 13th month of orthodontic therapy. Original CBCT data before surgery (T0), at the end of treatment (T1), 2years postoperatively (T2) and 5years postoperatively (T3) were collected and reconstructed for 3-dimensional (3D) qualitative analyse. At the end of the surgical-orthodontic treatment (26months), good function and good aesthetics were achieved. The qualitative and comparative analysis of the superimpositions and the cuts made on the CBCT at T0, T1, T2, T3 showed a physiological remodelling and adaptation of the condyles.
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Morphologic Changes of the Temporomandibular Joint in Pruzansky-Kaban Type IIa Hemifacial Microsomia Postmandibular Distraction Osteogenesis. J Craniofac Surg 2023; 34:591-596. [PMID: 36857566 DOI: 10.1097/scs.0000000000008854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/10/2022] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Mandibular distraction osteogenesis (MDO) is a powerful tool for the correction of hemifacial microsomia (HFM). The temporomandibular joint (TMJ) is the focus of attention in the diagnosis and treatment of HFM. This observational retrospective cross-sectional study aimed to investigate morphologic changes in TMJ post-MDO in type IIa HFM. METHODS We recruited 48 patients with unilateral type IIa HFM who had completed MDO and mandibular distractor extraction (MDE). Data relating to the length, distance, angle, and volume of the TMJ were measured on 3-dimension models created by the analysis of computed tomography data. Normality analysis was performed by using the Shapiro-Wilk test. Data were compared with the paired t test and Wilcoxon signed-ranks test. RESULTS The spaces between the affected condyle and the affected glenoid fossa before MDO were all significantly larger than before MDE (P<0.05). The breadth of the affected glenoid fossa before MDO was significantly longer than before MDE (P<0.001). The height of the affected condyle before MDO was significantly longer than before MDE (P<0.001). The volume of the affected condyle before MDO was significantly larger than before MDE (P<0.001). The ratio between the volume of the affected condyle and unaffected condyle before MDO was 0.20±0.13. The ratio between the volume of the affected condyle before MDE and MDO was 0.65±0.32. The resorption rate of the affected condyle post-MDO was 0.35±0.32. CONCLUSION Herein, we characterized anatomic changes of the TMJ in type- IIa HFM post-MDO. Condylar resorption and the compression of space between the condyle and the glenoid fossa on the affected side were 2 typical manifestations. Our findings enhanced the understanding of the application of MDO on HFM.
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Three-Dimensional Changes in the Mandibular Proximal Segment After Using a Surgery-First Approach in Patients With Class III Malocclusion and Facial Asymmetry. J Craniofac Surg 2022; 33:1956-1961. [PMID: 35175981 PMCID: PMC9378743 DOI: 10.1097/scs.0000000000008520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study was performed to evaluate condylar position and angulation after asymmetric mandibular setback between a conventional (CA) and surgery-first approach (SFA) using three-dimensional analysis. The condylar positions of 30 patients with skeletal Class III malocclusion and facial asymmetry who underwent 1-jaw (sagittal split ramus osteotomy) or 2-jaw orthognathic surgery (Le Fort I osteotomy and sagittal split ramus osteotomy) with CA (n = 18) or SFA (n = 12) from 2 university hospitals were studied. The three-dimensional assessment of condylar changes was performed using computed tomography images at the initial time point (T0) and at least 6 months after surgery (T1). Segmentation of condyles and cranial base assessment from cone-beam computed tomography images were performed using ITK-SNAP software (version 3.4.0). Condylar position and angulation changes were calculated using 3D Slicer software (version 4.10.2), and statistical analysis was performed. No significant translational or rotational condylar changes were observed between the deviated and nondeviated sides in each group or between the CA and SFA groups except yaw (P = 0.014). Linear mixed-model analysis and multivariate analysis showed no significant difference between the CA and SFA groups. Surgery-first approach might not be associated with more harmful effects on the condylar position and angulation changes as compared with CA.
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15
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Holte MB, Sæderup H, Pinholt EM. Comparison of surface- and voxel-based registration on the mandibular ramus for long-term three-dimensional assessment of condylar remodelling following orthognathic surgery. Dentomaxillofac Radiol 2022; 51:20210499. [PMID: 35143288 PMCID: PMC9499205 DOI: 10.1259/dmfr.20210499] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to validate and compare the accuracy and reliability of surface- and voxel-based registration on the mandibular rami for long-term three-dimensional (3D) evaluation of condylar remodelling following Orthognathic Surgery. METHODS The mandible was 3D reconstructed from a pair of superimposed pre- and postoperative (two years) cone-beam computerized tomography scans and divided into the condyle, and 21 ramal regions. The accuracy of surface- and voxel-based registration was measured by the absolute mean surface distance of each region after alignment of the pre- and postoperative rami. To evaluate the reliability, mean absolute differences and intra class correlation coefficients (ICC) were calculated at a 95% confidence interval on volumetric and surface distance measurements of two observers. Paired t-tests were applied to statistically evaluate whether the accuracy and reliability of surface- and voxel-based registration were significantly different (p < 0.05). RESULTS A total of twenty subjects (sixteen female; four male; mean age 27.6 years) with class II malocclusion and maxillomandibular retrognathia, who underwent bimaxillary surgery, were included. Surface-based registration was more accurate and reliable than voxel-based registration on the mandibular ramus two years post-surgery (p < 0.05). The inter observer reliability of using surface-based registration was excellent, ICC range [0.82-1.00]. For voxel-based registration, the inter observer reliability ranged from poor to excellent [0.00-0.98]. The measurement error introduced by applying surface-based registration for assessment of condylar remodelling was considered clinical irrelevant (1.83% and 0.18 mm), while the measurement error introduced by voxel-based registration was considered clinical relevant (5.44% and 0.52 mm). CONCLUSIONS Surface-based registration was proven more accurate and reliable compared to voxel-based registration on the mandibular ramus for long-term 3D assessment of condylar remodelling following Orthognathic Surgery. However, importantly, the performance difference may be caused by an inappropriate reference structure, proposed in the literature, and applied in this study.
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Affiliation(s)
- Michael Boelstoft Holte
- Department of Oral and Maxillofacial Surgery & University of Southern Denmark, Faculty of Health Sciences, Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
| | - Henrik Sæderup
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Odense, Denmark
| | - Else Marie Pinholt
- Department of Regional Health Research & University Hospital of Southern Denmark, Department of Oral and Maxillofacial Surgery, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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van Luijn R, Baan F, Shaheen E, Bergé S, Politis C, Maal T, Xi T. Three-dimensional analysis of condylar remodeling and skeletal relapse following LeFort-I osteotomy: A one-year follow-up bicenter study. J Craniomaxillofac Surg 2021; 50:40-45. [PMID: 34654618 DOI: 10.1016/j.jcms.2021.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to quantify the postoperative condylar remodeling after Le Fort I surgery. Patients treated with a Le Fort I osteotomy were investigated. CBCT scans were acquired preoperatively, one week and one year postoperatively. A preoperative 3D cephalometric analysis was performed on the preoperative CBCT. Surgical movements were quantified using a voxel-registration based method (OrthoGnaticAnalyser). After rendering of the condyles from the CBCT, a volumetric analysis was performed. The correlation between the surgical movement of the maxilla and the postoperative condylar volume changes was determined with analysis of variance. RESULTS: A total of 45 subjects were included in this study. 47 of 90 condyles (52%) showed a mean volume reduction of 93 mm3 (4.9 volume-%) postoperatively. The maxilla was impacted in 12 patients (2.44 ± 2.49 mm) and extruded in 33 patients (1.78 ± 1.29 mm). The maxillary impaction group showed a volume reduction of 50 ± 122 mm3 and the extrusion group showed a mean volume gain of 21 ± 139 mm3 (p = 0.028). CONCLUSION: Clinicians should be aware of potential condylar remodeling following solitary Le Fort I osteotomies, particularly in female patients with maxillary impaction.
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Affiliation(s)
- Rik van Luijn
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Frank Baan
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525, GA, Nijmegen, the Netherlands.
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Mohamed AAS, Abotaleb B, Ahmed Abdulqader A, Hongliang D, Sakran KA, He D. Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function. J Craniomaxillofac Surg 2021; 49:1035-1043. [PMID: 34217568 DOI: 10.1016/j.jcms.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 02/08/2023] Open
Abstract
This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment. Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides. The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space. CONCLUSION: The three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture.
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Affiliation(s)
- Abdo Ahmed Saleh Mohamed
- Department of Oral and Maxillofacial Surgery, Lanzhou University First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu Province, China; Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, 56th Lingyuanxi Road, Guangzhou, Guangdong, 510055, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - Bassam Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Abbas Ahmed Abdulqader
- Department of Orthodontic, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Du Hongliang
- Department of Oral and Maxillofacial Surgery, Lanzhou University First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu Province, China
| | - Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Dengqi He
- Department of Oral and Maxillofacial Surgery, Lanzhou University First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu Province, China.
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Van den Bempt M, Vinayahalingam S, Han MD, Bergé SJ, Xi T. The role of muscular traction in the occurrence of skeletal relapse after advancement bilateral sagittal split osteotomy (BSSO): A systematic review. Orthod Craniofac Res 2021; 25:1-13. [PMID: 33938136 PMCID: PMC9292715 DOI: 10.1111/ocr.12488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
The aim of this systematic review was (i) to determine the role of muscular traction in the occurrence of skeletal relapse after advancement BSSO and (ii) to investigate the effect of advancement BSSO on the perimandibular muscles. This systematic review reports in accordance with the recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Electronic database searches were performed in the databases MEDLINE, Embase and Cochrane Library. Inclusion criteria were as follows: assessment of relapse after advancement BSSO; assessment of morphological and functional change of the muscles after advancement BSSO; and clinical studies on human subjects. Exclusion criteria were as follows: surgery other than advancement BSSO; studies in which muscle activity/traction was not investigated; and case reports with a sample of five cases or fewer, review articles, meta‐analyses, letters, congress abstracts or commentaries. Of the initial 1006 unique articles, 11 studies were finally included. In four studies, an intervention involving the musculature was performed with subsequent assessment of skeletal relapse. The changes in the morphological and functional properties of the muscles after BSSO were studied in seven studies. The findings of this review demonstrate that the perimandibular musculature plays a role in skeletal relapse after advancement BSSO and may serve as a target for preventive strategies to reduce this complication. However, further research is necessary to (i) develop a better understanding of the role of each muscle group, (ii) to develop new therapeutic strategies and (iii) to define criteria that allow identification of patients at risk.
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Affiliation(s)
- Maxim Van den Bempt
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Michael D Han
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Shujaat S, Shaheen E, Politis C, Jacobs R. Three-dimensional evaluation of distal and proximal segment skeletal relapse following isolated mandibular advancement surgery in 100 consecutive patients: A one-year follow-up study. Int J Oral Maxillofac Surg 2021; 51:113-121. [PMID: 33888384 DOI: 10.1016/j.ijom.2021.03.020] [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: 10/20/2020] [Revised: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to perform a three-dimensional evaluation of the skeletal relapse of the proximal and distal mandibular segments following isolated bilateral sagittal split osteotomy advancement surgery. One hundred consecutive patients (mean age 25.8±11.7 years), comprising 65 female patients (mean age 26.4±12.1 years) and 35 male patients (mean age 24.6±11.0 years) requiring mandibular advancement without genioplasty, were enrolled prospectively in the study. Cone beam computed tomography scans were acquired for each patient at three time-points: preoperatively, immediately (1-6 weeks) after surgery, and 1 year after surgery. A validated tool was utilized to assess the surgical movement and relapse. Based on percentage, the majority of the distal and proximal translational and rotational movements relapsed within the range of ≤2mm and ≤2°. The distal segment revealed a significant relapse in a posterior, inferior, and clockwise pitch direction. Both left and right proximal segments showed a significant translational relapse in the medial, posterior, and superior direction. Amongst the rotational parameters, proximal segments relapsed significantly in clockwise pitch, clockwise roll, and counterclockwise yaw direction. Overall, both distal and proximal bone segments showed a clinically acceptable translational and rotational stability. The proximal segments torqued towards their original position with a reduction of flaring.
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Affiliation(s)
- S Shujaat
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - E Shaheen
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - C Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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20
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Pachnicz D, Ramos A. Mandibular condyle displacements after orthognathic surgery-an overview of quantitative studies. Quant Imaging Med Surg 2021; 11:1628-1650. [PMID: 33816197 DOI: 10.21037/qims-20-677] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The repositioning of bone segments during orthognathic surgeries often results in mandibular condyle positional changes and can also affect jaw muscles, soft tissues and the temporomandibular joint (TMJ). Condylar displacements are considered as one of the factors of bone remodeling and further skeletal relapse. The quantitative approach is commonly used in comparative analyses and evaluations of the relationships between examined factors. The aim of this study is the overview of the current literature including quantitative analysis in the research of mandibular condyle positional changes as a consequence of orthognathic surgeries. Thirty articles were included in the overview. Most of the articles present a comparative and evaluative analysis of treatment results concerning different surgical approaches, fixation methods or types of skeletal defects. The correlation between condylar displacements and bone remodeling, skeletal relapse and TMJ dysfunctions were considered. The most frequently repeated study variables were: short-term changes, Class III malocclusion, yaw rotation, 3D cephalometry measurements. Quantitative data might be useful in the evaluation of patterns and range of condylar displacements for specific treatment conditions. Available literature concerning the analysed topic is characterized by great heterogeneity with regards to the purpose and methodologies of the studies. More systematic approaches and long-term considerations are needed in future research.
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Affiliation(s)
- Dominik Pachnicz
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - António Ramos
- TEMA, Biomechanics Research Team, Mechanical Engineering Department, University of Aveiro, Aveiro, Portugal
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21
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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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Thiem DGE, Schneider D, Hammel M, Saka B, Frerich B, Al-Nawas B, Kämmerer PW. Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery-a retrospective, cross-sectional long-term analysis. Clin Oral Investig 2020; 25:3315-3327. [PMID: 33155066 PMCID: PMC8060167 DOI: 10.1007/s00784-020-03664-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/28/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. MATERIALS AND METHODS In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0-4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. RESULTS Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients' self-perception (85.4%), with 60.4% of patients opting for surgery again. CONCLUSIONS Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. CLINICAL RELEVANCE Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.
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Affiliation(s)
- Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany. .,Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | | | | | - Bassam Saka
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany.,Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
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Torgersbråten N, Stenvik A, Espeland L. Bimaxillary surgery to correct high-angle class II malocclusion: does a simultaneous genioplasty affect long-term stability? Eur J Orthod 2020; 42:426-433. [PMID: 31369666 DOI: 10.1093/ejo/cjz055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES High-angle skeletal Class II malocclusion is one of the most challenging dentofacial deviations to treat and, in adults, a combination of orthodontic treatment and bimaxillary orthognathic surgery is often indicated. This study examines the rate of clinically significant relapse and whether a genioplasty affects the treatment outcome of high-angle Class II malocclusions. MATERIAL AND METHODS Cephalometric tracings of 36 consecutively treated high-angle Class II patients were evaluated from pre-surgery to 3 years post-surgery. All patients had undergone bimaxillary surgery (Le Fort I and BSSO), 13 of them had in addition a genioplasty. RESULTS The maxilla remained stable, whereas relapse (greater than or equal to 2 mm) of the mandibular advancement was seen in 40 per cent of the patients. Advancement greater than 10 mm increased the risk for horizontal relapse. The overjet was normalized and remained stable despite mandibular relapse. Half of the patients had an anterior open bite 3 years post-surgery. A supplemental genioplasty did not affect the relapse rate. CONCLUSIONS AND IMPLICATIONS Overjet was normalized and remained stable long term; there was an open bite in half of the patients. Combined orthodontic and bimaxillary surgical treatment of high-angle Class II patients showed skeletal relapse (greater than or equal to 2 mm) of the mandible in 40 per cent of patients. Mandibular advancement greater than 10 mm increased the risk for relapse. There was no increased risk for dental or skeletal instability associated with a genioplasty in combination with maxillary and mandibular surgery in the treatment of high-angle skeletal Class II malocclusion.
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Affiliation(s)
| | - Arild Stenvik
- Department of Orthodontics, University of Oslo, Norway
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Takasu H, Hirota M, Yamashita Y, Iwai T, Fujita K, Mitsudo K. Straight Locking Miniplate Technique Achieves Submillimeter Accuracy of Condylar Positional Change During Bimaxillary Orthognathic Surgery for Patients With Skeletal Class III Malocclusion. J Oral Maxillofac Surg 2020; 78:1834.e1-1834.e9. [PMID: 32428461 DOI: 10.1016/j.joms.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The straight locking miniplate (SLM) technique is a straightforward method to accurately reposition the maxilla during bimaxillary orthognathic surgery. The present study evaluated the accuracy of the SLM technique in maintaining the condylar position during surgery without the use of a cutting guide. PATIENTS AND METHODS The present prospective, single-center study was conducted at Yokohama City University between 2016 and 2017 and included patients with skeletal Class III malocclusion. The patients were divided into 2 groups according to the fixation method used for the mandibular segments. The mandibular segments were fixed with miniplates either manually (manual group) or using the SLM technique (SLM group). Computed tomography was performed before and 3 days after surgery to compare the condylar position. The bodily and rotational movements of the condyle were analyzed. RESULTS The subjects were 18 Japanese patients (36 condyles) who had undergone bilateral set back surgery with Le Fort I osteotomy. The amount of bodily movements in the manual and SLM groups were 1.44 and 0.62 mm, respectively. The degree of rotational movement in the sagittal plane in the manual and SLM groups was 3.33° and 0.23°, respectively. The bodily and rotational movements in the SLM group were significantly smaller than those in the manual group (P < .05 and P < .01, respectively). CONCLUSIONS These results suggest that use of the SLM technique reduces the risk of condylar positional changes to less than 1 mm during orthognathic surgery without the use of any complex devices or a cutting guide.
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Affiliation(s)
- Hikaru Takasu
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Hirota
- Director, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan.
| | - Yosuke Yamashita
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshinori Iwai
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koichi Fujita
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenji Mitsudo
- Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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25
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Skroch L, Fischer I, Meisgeier A, Kozolka F, Apitzsch J, Neff A. Condylar remodeling after osteosynthesis of fractures of the condylar head or close to the temporomandibular joint. J Craniomaxillofac Surg 2020; 48:413-420. [DOI: 10.1016/j.jcms.2020.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022] Open
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Chen Y, Zhang J, Han Y, Ferraro N, August M. Interaction analysis of risk factors for long-term skeletal relapse following mandibular advancement with bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2020; 49:350-355. [DOI: 10.1016/j.ijom.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/23/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022]
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Verhelst P, Verstraete L, Shaheen E, Shujaat S, Darche V, Jacobs R, Swennen G, Politis C. Three-dimensional cone beam computed tomography analysis protocols for condylar remodelling following orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg 2020; 49:207-217. [DOI: 10.1016/j.ijom.2019.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
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28
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Verhelst PJ, Shaheen E, de Faria Vasconcelos K, Van der Cruyssen F, Shujaat S, Coudyzer W, Salmon B, Swennen G, Politis C, Jacobs R. Validation of a 3D CBCT-based protocol for the follow-up of mandibular condyle remodeling. Dentomaxillofac Radiol 2019; 49:20190364. [PMID: 31674794 PMCID: PMC7068073 DOI: 10.1259/dmfr.20190364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Three-dimensional models of mandibular condyles provide a way for condylar remodeling follow-up. The overall aim was to develop and validate a user-friendly workflow for cone beam CT (CBCT)-based semi-automatic condylar registration and segmentation. METHODS A rigid voxel-based registration (VBR) technique for registration of two post-operative CBCT-scans was tested. Two modified mandibular rami, with or without gonial angle, were investigated as the volume of interest for registration. Inter- and intraoperator reproducibility of this technique was tested on 10 mandibular rami of orthognathic patients by means of intraclass correlation coefficients (ICC's) and descriptive statistics of the transformation values from the VBR. The difference in reproducibility between the two modified rami was evaluated using a paired t-test (p < 0.05). For the segmentation, eight fresh frozen cadaver heads were scanned with CBCT and micro-CT. These data were used to test the inter- and intraoperator reproducibility (ICC's) and accuracy (Bland-Altman plot) of a newly designed workflow based on semi-automated contour enhancement. RESULTS Excellent ICC's (0.94-0.99) were obtained for the voxel-based registration technique using both modified rami. If the gonial angle was not included in the volume of interest, there was a trend of increased operator error suggested by significant higher interoperator differences in translation values (p = 0,0036). The segmentation workflow proved to be highly reproducible with excellent ICC's (0.99), low absolute mean volume differences between operators (23.19 mm3), within operators (28.93 mm3) and low surface distances between models of different operators (<0.20 mm). Regarding the accuracy, CBCT-models slightly overestimate the condylar volume compared to micro-CT. CONCLUSIONS This study provides a validated user-friendly and reproducible method of creating three-dimensional-surface models of mandibular condyles out of longitudinal CBCT-scans.
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Affiliation(s)
- Pieter-Jan Verhelst
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Fréderic Van der Cruyssen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Benjamin Salmon
- Orofacial Pathologies, Imaging and Biotherapies EA2496 Lab, University of Paris, Montrouge, France.,Dental Medicine Department, AP-HP, Bretonneau Hospital, Paris, France
| | - Gwen Swennen
- Division of Maxillofacial Surgery, Department of Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Chen Y, Zhang J, Rao N, Han Y, Ferraro N, August M. Do Patients With Different Mandibular Plane Angles Have Different Time to Relapse After Bilateral Sagittal Osteotomy With Mandibular Advancement? J Oral Maxillofac Surg 2019; 78:455-466. [PMID: 31629758 DOI: 10.1016/j.joms.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE This study sought to answer the following question: Do patients with different mandibular plane angles (MPAs) have a different time to relapse after mandibular advancement with bilateral sagittal split osteotomy? MATERIALS AND METHODS We performed a retrospective cohort study of patients who underwent bilateral sagittal split osteotomy advancement at Massachusetts General Hospital between 2005 and 2017. The primary predictor variable was MPA, categorized as low (<25°), medium (between 25° and 35°), or high (>35°). The outcome variable was time to relapse (≥2-mm posterior change at the B point). Other covariates included gender, age, temporomandibular joint symptoms, bimaxillary surgery, direction of mandibular rotation, magnitude of advancement, genioplasty, and fixation method. Time to relapse was estimated using the Kaplan-Meier method. Cox and parametric regressions for interval-censored data were performed. P < .05 was considered statistically significant. RESULTS The sample was composed of 58 patients (40 female patients), with a mean age of 26.1 ± 4.9 years, grouped as follows: low MPA, n = 15; medium MPA, n = 26; and high MPA, n = 17. Clinically significant relapse was found in 18 patients (31%). Age, temporomandibular joint symptoms, counterclockwise rotation, and magnitude of advancement were statistically significantly different among the 3 groups. When we assessed time to relapse, the Kaplan-Meier method showed that high-MPA patients had a longer mean time at risk and higher estimated probabilities of relapse at different time points compared with low- and medium-MPA patients (P < .05). However, this association was not significant in Cox and parametric regressions. CONCLUSIONS Our results suggest that clinically significant relapse was found during the first postoperative year in low-MPA patients and from 2 to 5 years postoperatively in high-MPA patients. Multivariate regression analyses did not show a significant association between MPA and time to relapse, suggesting that other covariates may play a role in the observed time to relapse.
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Affiliation(s)
- Youbai Chen
- Resident, Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China; Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and MS Candidate in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Jie Zhang
- Research Fellow, Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Naman Rao
- Student, MS Candidate in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Yan Han
- Department Head and Professor, Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nalton Ferraro
- Associate Professor, Harvard School of Dental Medicine, Boston, MA
| | - Meredith August
- Director, Center for Applied Clinical Investigation, and Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA; and Associate Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA.
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Evaluation of the postoperative stability of a counter-clockwise rotation technique for skeletal class II patients by using a novel three- dimensional position-posture method. Sci Rep 2019; 9:13196. [PMID: 31519983 PMCID: PMC6744461 DOI: 10.1038/s41598-019-49335-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 08/23/2019] [Indexed: 11/09/2022] Open
Abstract
The aim of this study is to evaluate the postsurgical stability of skeletal class II patients after performing a counter-clockwise rotational (CCWR) procedure for the maxilla-mandibular complex (MMC) by using a novel Three-dimensional (3D) Position-Posture(P-P) measuring method. Twenty-five patients (5 males and 20 females) were included in this study. The postoperative CT scans of the skull were taken before surgery(T0), 3-7 days (T1), 3 months (T2), and 6 months (T3) after surgery. Specific anatomic landmarks were chosen to determine the position of the segments, while three equally perpendicular planes were created to describe their posture. The results show that the linear relapse of maxillary landmarks during the follow-up were acceptable (≤0.5 mm). The relapse of maxillary pitch plane at 6-months follow-up is 1.52°, which is acceptable. There was a significant pitch plane relapse of the mandibular-body segment with an average of 1.86° between T1 and T2 models, 3.28° between T1 and T3 models. There was no significant difference between roll and yaw planes during the follow-up. We therefore conclude that the P-P method could be used to accurately analyze the postsurgical stability of skeletal class II orthognathic surgery cases. For CCWR procedures, it was also shown that the there is a tendency for recurrence most specially on the body of the mandible.
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Hasprayoon S, Liao YF. Large versus small mandibular counterclockwise rotation during bimaxillary surgical correction of class II deformities—a retrospective CBCT study on skeletal stability. Clin Oral Investig 2019; 24:1779-1788. [DOI: 10.1007/s00784-019-03040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/29/2019] [Indexed: 12/28/2022]
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Liebregts J, Baan F, van Lierop P, de Koning M, Bergé S, Maal T, Xi T. One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery. Sci Rep 2019; 9:3000. [PMID: 30816184 PMCID: PMC6395738 DOI: 10.1038/s41598-019-39250-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/17/2019] [Indexed: 11/09/2022] Open
Abstract
Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.
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Affiliation(s)
- Jeroen Liebregts
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Frank Baan
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Philips van Leydenlaan 25, 6525 EX, Nijmegen, The Netherlands.,Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter van Lierop
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Martien de Koning
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Thomas Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.,Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
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Computer-Aided Surgical Simulation for Yaw Control of the Mandibular Condyle and Its Actual Application to Orthognathic Surgery: A One-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112380. [PMID: 30373219 PMCID: PMC6267607 DOI: 10.3390/ijerph15112380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
Background: Favourable occlusal interdigitation and an optimized position of the mandibular condyle after surgery are essential for obtaining favourable results. The position of the condyle is determined during the operation. However, it is difficult to maintain the condyle’s original position post-surgery despite the efforts of the surgeons. Indeed, a degree of rotation of the condyle is unavoidable, since it is difficult to verify whether the condyle is positioned correctly during surgery. Purpose: To maximize contact between the bone segments, the condyle was rotated around the vertical axis using surgical simulations. We examined changes to the condyle-fossa relationship after comparing virtual surgery to actual surgery. Methods: From 2015 to 2017, 20 patients were diagnosed with skeletal malocclusion and participated in computer-aided surgical simulation before undergoing orthognathic surgery. In the simulation, the mandibular condyles were rotated around the vertical axis, and the proximal segments were fixed to the distal segments using a customized miniplate and positioning device during actual surgery. This study investigated the relationship between the condyle and fossa using cone-beam computed tomography for several different time periods (preoperative (T0), virtual surgery (Tv), postoperative three days (T1) and one year (T2)). Results: The coronal and sagittal view exhibited significant differences in the mean values between T1and T0, Tv, and T2 for all joint spaces. As a result of the distance, the mean value of T2 in both the superior joint space (JS) and the lateral JS was significantly higher than that of Tv. In contrast, the mean value of Tv in the medial JS was significantly higher than that of T2. Moreover, the mean value of T2 on the axial plane was significantly larger than the values of Tv and T1. The mean value of T0 was also significantly larger than those of Tv and T1, and the mean value of Tv was larger than that of T1. Although the condyle was rotated, it exhibited a tendency to return to its preoperative position. There was no statistically significant difference in functional evaluation between T0 and T2. Conclusion: Our method of using yaw control for the condyle during virtual surgery and transferring this technique to the actual surgery can improve the conventional surgical technique by positioning the proximal segment in a pre-planned position, thus achieving optimal results.
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Gomes LR, Soares Cevidanes LH, Gomes MR, Carlos de Oliveira Ruellas A, Obelenis Ryan DP, Paniagua B, Wolford LM, Gonçalves JR. Three-dimensional quantitative assessment of surgical stability and condylar displacement changes after counterclockwise maxillomandibular advancement surgery: Effect of simultaneous articular disc repositioning. Am J Orthod Dentofacial Orthop 2018; 154:221-233. [PMID: 30075924 DOI: 10.1016/j.ajodo.2017.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In this study, we quantitatively assessed 3-dimensional condylar displacement during counterclockwise maxillomandibular advancement surgery (CMMA) with or without articular disc repositioning, focusing on surgical stability in the follow-up period. METHODS The 79 patients treated with CMMA had cone-beam computed tomography scans taken before surgery, immediately after surgery, and, on average, 15 months postsurgery. We divided the 142 condyles into 3 groups: group 1 (n = 105), condyles of patients diagnosed with symptomatic presurgical temporomandibular joint articular disc displacement who had articular disc repositioning concomitantly with CMMA; group 2 (n = 23), condyles of patients with clinical verification of presurgical articular disc displacement who had only CMMA; and group 3 (n = 14), condyles of patients with healthy temporomandibular joints who had CMMA. Presurgical and postsurgical 3-dimensional models were superimposed using voxel-based registration on the cranial base. Three-dimensional cephalometrics and shape correspondence were applied to assess surgical and postsurgical displacement changes. RESULTS Immediately after surgery, the condyles moved mostly backward and medially and experienced lateral yaw, medial roll, and upward pitch in the 3 groups. Condyles in group 1 showed downward displacement, whereas the condyles moved upward in groups 2 and 3 (P ≤0.001). Although condylar displacement changes occurred in the 3 groups, the overall surgical procedure appeared to be fairly stable, particularly for groups 1 and 3. Group 2 had the greatest amount of relapse (P ≤0.05). CONCLUSIONS CMMA has been shown to be a stable procedure for patients with healthy temporomandibular joints and for those who had simultaneous articular disc repositioning surgery.
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Affiliation(s)
- Liliane Rosas Gomes
- Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil.
| | | | | | | | | | - Beatriz Paniagua
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Larry Miller Wolford
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Baylor University Medical Center, Dallas, Tex
| | - João Roberto Gonçalves
- Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
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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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Counterclockwise maxillomandibular advancement surgery and disc repositioning: can condylar remodeling in the long-term follow-up be predicted? Int J Oral Maxillofac Surg 2017; 46:1569-1578. [PMID: 28728709 DOI: 10.1016/j.ijom.2017.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/21/2017] [Indexed: 11/23/2022]
Abstract
This study investigated predictive risk factors of condylar remodeling changes after counterclockwise maxillomandibular advancement (CCW-MMA) and disc repositioning surgery. Forty-one female patients (75 condyles) treated with CCW-MMA and disc repositioning had cone beam computed tomography (CBCT) scans taken pre-surgery, immediately after surgery, and at an average 16 months post-surgery. Pre- and post-surgical three-dimensional models were superimposed using automated voxel-based registration on the cranial base to evaluate condylar displacements after surgery. Regional registration was performed to assess condylar remodeling in the follow-up period. Three-dimensional cephalometrics, shape correspondence (SPHARM-PDM), and volume measurements were applied to quantify changes. Pearson product-moment correlations and multiple regression analysis were performed. Highly statistically significant correlation showed that older patients were more susceptible to overall condylar volume reduction following CCW-MMA and disc repositioning (P≤0.001). Weak but statistically significant correlations were observed between condylar remodeling changes in the follow-up period and pre-surgical facial characteristics, magnitude of the surgical procedure, and condylar displacement changes. After CCW-MMA and disc repositioning, the condyles moved mostly downwards and medially, and were rotated medially and counterclockwise; displacements in the opposite direction were correlated with a greater risk of condylar resorption. Moreover, positional changes with surgery were only weakly associated with remodeling in the follow-up period, suggesting that other risk factors may play a role in condylar resorption.
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Suda D, Ohazama A, Maeda T, Kobayashi T. The effect of bone mass and architecture on mandibular condyle after mandibular distraction. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:339-347. [PMID: 28864292 DOI: 10.1016/j.oooo.2017.05.472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/18/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Mandibular distraction surgery is a critical treatment for jaw deformity. However, abnormal mandibular condylar bone resorption is often seen as complication after surgery. Our previous study using a rat mandibular distraction model suggested that overloading leads to mandibular condylar resorption. Host factors are also believed to influence the resorption. To understand the relationship between host factors and resorption, we investigated the effect of changing bone mass and architecture on the mandibular condyle using FK506. STUDY DESIGN FK506, an immunosuppressant, was used to compromise bone mass and architecture in this study. Animals were divided into 4 groups: distraction surgery (Dist), FK506 administration (FK), distraction surgery with FK506 administration (FK + Dist), and no surgery or FK506 administration (Cont). RESULTS The FK group showed reduced bone mass and impaired bone architecture. The Dist group exhibited abnormal bone resorption on the surface of the condyles, which was slightly exacerbated in the FK + Dist group. Bone defect length decreased over time as a result of bone apposition in the Dist group. However, in the FK + Dist group, the bone defect length remained the same. CONCLUSIONS These results suggest that bone mass and architecture strongly affect the tolerance to the overloading and adaptation with bone apposition in condylar resorption site.
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Affiliation(s)
- Daisuke Suda
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Atsushi Ohazama
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeyasu Maeda
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Center for Advanced Oral Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadaharu Kobayashi
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Nova I, Kallus S, Berger M, Ristow O, Eisenmann U, Freudlsperger C, Hoffmann J, Dickhaus H. Computer assisted positioning of the proximal segment after sagittal split osteotomy of the mandible: Preclinical investigation of a novel electromagnetic navigation system. J Craniomaxillofac Surg 2017; 45:748-754. [PMID: 28318915 DOI: 10.1016/j.jcms.2017.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/06/2016] [Accepted: 01/30/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Modifications of the temporomandibular joint position after mandible osteotomy are reluctantly accepted in orthognathic surgery. To tackle this problem, we developed a new navigation system using miniaturized electromagnetic sensors. Our imageless navigation approach is therefore optimized to avoid complications of previously proposed optical approaches such as the interference with established surgical procedures and the line of sight problem. MATERIAL AND METHODS High oblique sagittal split osteotomies were performed on 6 plastic skull mandibles in a laboratory under conditions comparable to the operating theatre. The subsequent condyle reposition was guided by an intuitive user interface and performed by electromagnetic navigation. To prove the suitability and accuracy of this novel approach for condyle navigation, the positions of 3 titanium marker screws placed on each of the proximal segments were compared using pre- and postoperative Cone Beam Computed Tomography (CBCT) imaging. RESULTS Guided by the electromagnetic navigation system, positioning of the condyles was highly accurate in all dimensions. Translational discrepancies up to 0,65 mm and rotations up to 0,38° in mean could be measured postoperatively. There were no statistically significant differences between navigation results and CBCT measurements. CONCLUSION The intuitive user interface provides a simple way to precisely restore the initial position and orientation of the proximal mandibular segments. Our electromagnetic navigation system therefore yields a promising approach for orthognathic surgery applications.
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Affiliation(s)
- Igor Nova
- Department of Medical Biometry and Informatics (Chair: Meinhard Kieser MSc, PhD), University Hospital Heidelberg, Germany.
| | - Sebastian Kallus
- Department of Medical Biometry and Informatics (Chair: Meinhard Kieser MSc, PhD), University Hospital Heidelberg, Germany
| | - Moritz Berger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Urs Eisenmann
- Department of Medical Biometry and Informatics (Chair: Meinhard Kieser MSc, PhD), University Hospital Heidelberg, Germany
| | | | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - Hartmut Dickhaus
- Department of Medical Biometry and Informatics (Chair: Meinhard Kieser MSc, PhD), University Hospital Heidelberg, Germany
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Mücke T, Löffel A, Kanatas A, Karnezi S, Rana M, Fichter A, Haarmann S, Wolff KD, Loeffelbein DJ. Botulinum toxin as a therapeutic agent to prevent relapse in deep bite patients. J Craniomaxillofac Surg 2016; 44:584-9. [PMID: 27020772 DOI: 10.1016/j.jcms.2016.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/28/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The etiology of deep bite is multifactorial. One of the causes is increased muscular activity. This makes the treatment of deep bite malocclusions difficult and often results in relapse in many cases. In this work we compared patients with surgical orthognathic treatment only and surgical orthognathic treatment with additional injections of botulinum toxin after mandibular advancement for class II division 2 malocclusion. MATERIAL AND METHODS This is a prospective study. Adult patients were assessed pretreatment (T1), posttreatment (T2), and long-term after 1 year (T3). In total, 32 patients (mean age, 30.7 years; 23 women and 9 men) reached the study end point (T3); 24 patients were treated without botulinum toxin and 8 patients received preoperative injections of botulinum toxin. RESULTS Significant differences between both groups were observed, with a more stable result for the experimental group treated with botulinum toxin. DISCUSSION In a selective group of adult patients with a class II division II incisor relationship and with a class II skeletal base, botulinum toxin injections can effectively prevent relapse. This may present an alternative to a conventional myotomy.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
| | - Anja Löffel
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK
| | - Sandy Karnezi
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK
| | - Majeed Rana
- Department of Oral and Maxillofacial Surgery, Medizinische Hochschule Hannover, Germany
| | - Andreas Fichter
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Stephan Haarmann
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Denys John Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
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