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Cohen A, Rushinek H, Cohen Sela M, Zok Ran L, Talisman S, Casap N. Effect of Orthognathic Surgery on Pre-existing Temporomandibular Disorders. J Craniofac Surg 2024:00001665-990000000-01374. [PMID: 38393302 DOI: 10.1097/scs.0000000000010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/10/2024] [Indexed: 02/25/2024] Open
Abstract
The management of patients with pre-existing temporomandibular disorders (TMDs) undergoing orthognathic surgery remains a subject of ongoing debate. This study aimed to profile these individuals and evaluate the correlation between orthognathic surgery and alterations in TMD indicators and symptoms. We conducted a retrospective cohort investigation involving patients with skeletal malocclusion and established TMDs. Variables of interest encompassed the performance of orthognathic surgery, documented TMDs (including temporomandibular joint (TMJ) sounds, TMJ pain, muscle discomfort, and jaw locking), and patients' self-assessments of TMJ and muscle pain using a visual analog scale (VAS). The primary outcome measures focused on changes in TMD indicators and symptoms. Among the study cohort, 73.4% exhibited skeletal class III malocclusion, while 26.6% presented with skeletal class II malocclusion. Notably, patients classified as skeletal class III were significantly younger than their skeletal class II counterparts (mean age: 23.06±5.37 vs. 26.71±7.33; P=0.034). The most prevalent pre-existing TMD complaint was TMJ sounds (65.5%), followed by TMJ pain (39.1%), muscle discomfort (23.4%), and jaw locking (12.5%). Skeletal class II patients were more likely to experience TMJ sounds compared to skeletal class III patients (88.2% vs. 57.4%; P=0.022). Statistically significant improvements were observed in the VAS assessments among class III patients following surgery. A majority of patients with pre-existing TMDs seeking orthognathic surgery exhibited skeletal class III malocclusion and were younger than those with skeletal class II malocclusion. Importantly, orthognathic surgery was associated with positive changes in TMD indicators and symptoms in these patients.
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Affiliation(s)
- Adir Cohen
- Department of Oral and Maxillofacial Surgery
| | | | | | | | - Shahar Talisman
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Nardy Casap
- Department of Oral and Maxillofacial Surgery
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Kim JY, Yong HS, Kim TY, Kim JY, Jeon KJ, Huh JK. Volumetric changes in temporomandibular joint space following trans-oral vertical ramus osteotomy in patients with mandibular prognathism: a one-year follow-up study. Sci Rep 2024; 14:942. [PMID: 38200085 PMCID: PMC10781718 DOI: 10.1038/s41598-023-51050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
This study measured and analyzed chronological changes in temporomandibular joint space volume by compartment following transoral vertical ramus osteotomy (TOVRO) using reconstructed 3-dimensional (3D) images of patients with mandibular prognathism. It included 70 joints of 35 patients who underwent TOVRO between January 2018 and December 2021. Computed tomography (CT) or cone-beam CT (CBCT) was performed before surgery (T0) and at 3 days (T1), 6 months (T2), and 12 months postoperatively (T3). These scans were then analyzed using 3D software. The volumes of the overall (Vjs), anterior (Vajs), posterior (Vpjs), medial (Vmjs), and lateral (Vljs) joint spaces were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used to evaluate significant changes in joint space volume over time. Vjs significantly increased to 134.54 ± 34.28 mm3 at T3 compared to T0 (p < 0.001). Vpjas and Vljs increased by 130.72 ± 10.07 mm3 and 109.98 ± 7.52 mm3 at T3 compared to T0, respectively (p < 0.001). However, no significant difference was observed between T0 and T2 in Vajs and Vmjs (p = 0.9999). The observed volume increases in Vpjs and Vljs appeared to contribute to the overall Vjs increase.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Hae-Seong Yong
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Tae-Yeong Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea
| | - Jun-Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea.
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Lin SI, McKenna SJ. What are the Effects of Internal Fixation on Trigeminal Neurosensory Function and the Temporomandibular Joints Following Intraoral Vertical Ramus Osteotomy? J Oral Maxillofac Surg 2023:S0278-2391(23)00216-1. [PMID: 36965515 DOI: 10.1016/j.joms.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Intraoral vertical ramus osteotomy (IVRO) has, traditionally, been accomplished without internal fixation, necessitating a period of maxillomandibular fixation (MMF). With advances in instrumentation, internal fixation of IVRO is feasible, obviating the need for MMF. The purpose is to investigate the effects of transoral internal fixation on the prevalence of third division trigeminal nerve (CNV3) injury, temporomandibular joint (TMJ) arthralgia, and surgical site bleeding following IVRO. MATERIALS AND METHODS A retrospective study was conducted on patients who underwent IVRO at Vanderbilt University Medical Center between January 2017 and December 2020. The primary predictor variable was fixation status-internal fixation versus MMF. The primary outcome variable was postoperative CNV3 neurosensory disturbance. The secondary outcome variables were TMJ arthralgia and surgical site bleeding. Statistical analysis included Fisher's exact test and McNemar's Chi-squared test. RESULTS Seventy two subjects (59 IVROs without internal fixation and 65 IVROs with internal fixation) were studied. The frequency of CNV3 neurosensory deficit was 0% in the IVRO without internal fixation group and 3.1% in the IVRO with internal fixation group (P = .49). Within group analysis showed a decreased frequency of postoperative TMJ arthralgia compared to preoperative records in both groups (IVRO without internal fixation group, P = .04 and IVRO with internal fixation group, P = .004). The frequency of active surgical site bleeding controlled with local measures was 1.7% in the IVRO without internal fixation group and 3.1% in the IVRO with internal fixation group (P = 1). CONCLUSION Internal fixation of IVRO is associated with low incidence of neurosensory deficit, TMJ arthralgia, and active surgical site bleeding.
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Affiliation(s)
- Susie I Lin
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center
| | - Samuel J McKenna
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center.
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Peleg O, Mahmoud R, Shuster A, Arbel S, Kleinman S, Mijiritsky E, Ianculovici C. Vertical Ramus Osteotomy, Is It Still a Valid Tool in Orthognathic Surgery? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10171. [PMID: 36011805 PMCID: PMC9407762 DOI: 10.3390/ijerph191610171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study is to evaluate mandibular osteotomy procedures during orthognathic surgery, with an emphasis on the complications of the two leading procedures: intraoral vertical ramus osteotomy (IVRO) and sagittal split osteotomy (SSO). We conducted a retrospective cohort study by extracting the records of patients who underwent either IVRO or SSO procedures during orthognathic surgery in a single center between January 2010 and December 2019. A total of 144 patients were included (median age of 20.5 years, 52 males). The IVRO:SSO ratio was 118:26 procedures. When referring to all surgeries performed, IVRO procedures were associated with shorter hospitalization than the SSO procedures, while the overall durations of surgery and follow-up periods were comparable. In contrast, when referring only to bimaxillary procedures, the duration of the IVRO bimaxillary procedures was significantly shorter than the SSO bimaxillary procedures. There were 53 complications altogether. Postoperative complications consisting of skeletal relapse, temporomandibular joint dysfunction, sensory impairment, and surgical-site infection were significantly fewer in the IVRO group. Both types of osteotomies have acceptable rates of complications. IVRO appears to be a safer, simpler, though less acceptable procedure in terms of patient compliance.
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Affiliation(s)
- Oren Peleg
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Reema Mahmoud
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amir Shuster
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shimrit Arbel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shlomi Kleinman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Eitan Mijiritsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Clariel Ianculovici
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Park J, Hong KE, Yun JE, Shin ES, Kim CH, Kim BJ, Kim JH. Positional changes of the mandibular condyle in unilateral sagittal split ramus osteotomy combined with intraoral vertical ramus osteotomy for asymmetric class III malocclusion. J Korean Assoc Oral Maxillofac Surg 2021; 47:373-381. [PMID: 34713812 PMCID: PMC8564090 DOI: 10.5125/jkaoms.2021.47.5.373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 10/06/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES In the present study, the effects of sagittal split ramus osteotomy (SSRO) combined with intraoral vertical ramus osteotomy (IVRO) for the treatment of asymmetric mandible in class Ⅲ malocclusion patients were assessed and the postoperative stability of the mandibular condyle and the symptoms of temporomandibular joint disorder (TMD) evaluated. MATERIALS AND METHODS A total of 82 patients who underwent orthognathic surgery for the treatment of facial asymmetry or mandibular asymmetry at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital, from 2016 to 2021 were selected. The patients that underwent SSRO with IVRO were assigned to Group I (n=8) and patients that received bilateral SSRO (BSSRO) to Group II (n=10, simple random sampling). Preoperative and postoperative three-dimensional computed tomography (CT) axial images obtained for each group were superimposed. The condylar position changes and degree of rotation on the superimposed images were measured, and the changes in condyle based on the amount of chin movement for each surgical method were statistically analyzed. RESULTS Group I showed a greater amount of postoperative chin movement. For the amount of mediolateral condylar displacement on the deviated side, Groups I and II showed an average lateral displacement of 0.07 mm and 1.62 mm, respectively, and statistically significantly correlated with the amount of chin movement (P=0.004). Most of the TMD symptoms in Group I patients who underwent SSRO with IVRO showed improvement. CONCLUSION When a large amount of mandibular rotation is required to match the menton to the midline of the face, IVRO on the deviated side is considered a technique to prevent condylar torque. In the present study, worsening of TMD symptoms did not occur after orthognathic surgery in any of the 18 patients.
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Affiliation(s)
- Jun Park
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Ki-Eun Hong
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Ji-Eon Yun
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Eun-Sup Shin
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Chul-Hoon Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Bok-Joo Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Jung-Han Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, Korea
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Kim JY, You HS, Huh JK, Park KH. Is There a Difference in Condyle Position Changing Pattern Between Deviated and Non-Deviated Sides After Intraoral Vertical Ramus Osteotomy in Facial Asymmetry? J Oral Maxillofac Surg 2019; 78:629.e1-629.e10. [PMID: 31887295 DOI: 10.1016/j.joms.2019.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The position changing pattern of the condyles after intraoral vertical ramus osteotomy (IVRO) on the deviated and non-deviated sides is not clearly known. This study was conducted to evaluate the changes in condylar position after IVRO in patients with facial asymmetry and to compare the deviated and non-deviated sides using computed tomography imaging. MATERIALS AND METHODS This retrospective cohort study investigated patients with a diagnosis of mandibular prognathism with facial asymmetry who had undergone bilateral IVRO with Le Fort I osteotomy. Condylar positions were recorded on the non-deviated and deviated sides in the midaxial, midsagittal, and coronal planes at 3 time points using 3-dimensional analysis software: preoperatively (T1), at 6 months postoperatively (T2), and at 12 months postoperatively (T3). Linear and angular changes in condyle position were measured and analyzed between T1, T2, and T3. Reliability and comparative analyses were conducted. RESULTS Thirty-two patients were involved in this study. At T2, the most superior point of the condyle moved to 1.15 ± 0.24 mm (inferiorly) and 0.88 ± 0.23 mm (anteriorly) on the deviated side (P = .0002 and P = .0005, respectively) and to 0.99 ± 0.25 mm (inferiorly) and 1.08 ± 0.34 mm (anteriorly) on the non-deviated side, showing significant differences (P < .0001 and P = .0007, respectively) compared with T1. The condyle position showed a tendency to recover to its original position by T3. However, there were no statistically significant differences between T2 and T3 (P > .05). Furthermore, there were no statistically significant differences between the deviated and non-deviated sides over the entire follow-up period (P > .05). CONCLUSIONS The condyles did not completely recover to their preoperative positions until 12 months postoperatively. There was no significant difference between the deviated and non-deviated sides in mandibular prognathism with facial asymmetry.
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Affiliation(s)
- Jae-Young Kim
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Han-Sol You
- Resident, Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Professor, Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kwang-Ho Park
- Professor, Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea.
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Song YL, Yap AUJ. Impact of pain-related temporomandibular disorders on jaw functional limitation, psychological distress and quality of life in postoperative class III East Asian patients. Clin Oral Investig 2019; 24:953-961. [DOI: 10.1007/s00784-019-02994-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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Sefidroodi M, Lobekk OK, Løes S, Schilbred Eriksen E. Temporomandibular joint function 10-15 years after mandibular setback surgery and six weeks of intermaxillary fixation. J Appl Oral Sci 2019; 27:e20180510. [PMID: 31166550 PMCID: PMC6534369 DOI: 10.1590/1678-7757-2018-0510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/02/2018] [Indexed: 11/22/2022] Open
Abstract
Intermaxillary fixation (IMF) is a classic method for immobilization of the mandible after mandibular fractures and corrective surgery. However, it has been suggested that IMF may be a risk for developing temporomandibular joint (TMJ)-related symptoms, especially when applied for longer periods.
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Affiliation(s)
| | - Ole Kristian Lobekk
- University of Bergen, Faculty of Medicine, Department of Clinical Dentistry, Bergen, Norway
| | - Sigbjørn Løes
- University of Bergen, Faculty of Medicine, Department of Clinical Dentistry, Bergen, Norway.,Haukeland University Hospital, Department of Maxillofacial Surgery, Bergen, Norway
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Lee CH, Cho SW, Kim JW, Ahn HJ, Kim YH, Yang BE. Three-dimensional assessment of condylar position following orthognathic surgery using the centric relation bite and the ramal reference line: A retrospective clinical study. Medicine (Baltimore) 2019; 98:e14931. [PMID: 30896656 PMCID: PMC6709179 DOI: 10.1097/md.0000000000014931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Orthognathic surgery (OGS) is a relatively common procedure for solving functional and aesthetic problems in facial and jaw areas in patients with dentofacial deformities. The positioning of the mandibular condylar segment during OGS has an impact on the surgical outcome. This study aimed to investigate the changes in the condyle-fossa relationship three dimensionally after OGS using the centric relation (CR) bite and the ramal reference line (RRL).Thirty-two patients with skeletal malocclusion underwent OGS. Condylar repositioning was performed using the CR bite, as previously reported. A RRL was added to the existing method and used during the surgery. Cone-beam computed tomography scans were acquired at 4 time points. Sixty-four condyles were evaluated in the coronal, sagittal, and axial views. Two groups were created according to the amount of mandible setback (SB1 vs SB2), and another 2 groups were created according to the maxillary operation (1-jaw vs 2-jaw). Each was then compared at the 4 time points. Differences between the values before (T0) and a year after surgery (T3) were also investigated. The positions of the pogonion and the menton were examined at T2 and T3 for the simple evaluation of relapse.The change in the condylar position was significant over a time-course (P < .001) but not between T0 and T3 (P > .05). Neither the setback amount nor the maxillary operation affected the positional change (P > .05). There were no significant changes between T2 and T3 in the relapse evaluation.This condylar repositioning method using the CR bite and a RRL showed stable results after OGS. This method is noninvasive and cost-effective and can be easily performed even by an inexperienced surgeon because it reduces errors in repositioning the condyle during OGS.
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Affiliation(s)
- Chang-Hyeon Lee
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
| | - Seoung-Won Cho
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
| | - Ju-Won Kim
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
| | - Hyo-Jung Ahn
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
- Department of Orthodontics
| | - Young-Hee Kim
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
- Department of Image Science in Dentistry, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University College of Medicine Sacred Heart Hospital, Anyang-Si
- Graduate School of Clinical Dentistry
- Institute of Clinical Dentistry, Hallym University, Chuncheon
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Park JC, Lee J, Lim HJ, Kim BC. Rotation tendency of the posteriorly displaced proximal segment after vertical ramus osteotomy. J Craniomaxillofac Surg 2018; 46:2096-2102. [PMID: 30318326 DOI: 10.1016/j.jcms.2018.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
Intraoral Vertical Ramus Osteotomy (IVRO) is one of the operative techniques used for orthognathic surgery. The aim of this study was to assess the posterior displacement of the proximal segment in patients undergoing IVRO at 1-year follow-up. In total, 52 hemimandibles from 26 patients who underwent IVRO in whom the proximal segment was posteriorly displaced without overlap with the distal segment at immediate post-operation (Imm) (30 cases, experimental group), and 26 patients in whom the proximal segment was not posteriorly displaced with overlap with the distal segment (Imm) (22 cases, control group) under three-dimensional computed tomography (3D CT) were included in the study. To analyze the movement of segments, the positions of the mid condyle point (MCP) and angle of condyle line (Con) were determined and the movement of the ramus angle (posterior edge of proximal segments) was measured at the proximal segment. Regression of the proximal segment in sagittal direction of the MCP was observed in both groups and all directions of the ramus angle in the experimental group, and only sagittal direction in the control group. In conclusion, posterior displacement of the proximal segment after IVRO showed tendency to regress its original position.
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Affiliation(s)
- Jong Chan Park
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea
| | - Jun Lee
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea
| | - Hun Jun Lim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea
| | - Bong Chul Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University College of Dentistry, Daejeon, Republic of Korea.
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Jung HD, Kim SY, Jung HS, Park HS, Jung YS. Immunohistochemical Analysis on Cortex-to-Cortex Healing After Mandibular Vertical Ramus Osteotomy: A Preliminary Study. J Oral Maxillofac Surg 2017; 76:437.e1-437.e8. [PMID: 29112826 DOI: 10.1016/j.joms.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The present study analyzed the expression of specific cytokines in the transforming growth factor (TGF)-β superfamily postoperatively after mandibular vertical ramus osteotomy (VRO). MATERIALS AND METHODS Four beagle dogs were enrolled and euthanized at 1, 2, 4, and 8 weeks postoperatively for immunohistochemical analysis using 6 specific antibodies (bone morphogenetic protein [BMP]-2/4, BMP-7, TGF-β2, TGF-β3, matrix metalloproteinase-3, and vascular endothelial growth factor [VEGF]). The results from the surgical site and control (adjacent area) were compared. RESULTS Generalized upregulation of BMP-2/4 was observed in all healing periods, and the strongest expression of BMP-7 was observed at 1 week postoperatively. The strongest expression of TGF-β2 was observed at 8 weeks with increasing pattern. The strong expression of TGF-β3 was observed at 1 and 4 weeks, with the strongest expression of VEGF at 1 week, with a decreasing pattern. No notable uptake was detected with the 6 specific antibodies in the adjacent bone (control). CONCLUSIONS The absence of internal fixation after VRO led to dynamic healing with a specific expression pattern of BMP-7 and TGF-β2. The anatomic factors, including sufficient preexisting vascularity, led to the earlier expression pattern of VEGF.
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Affiliation(s)
- Hwi-Dong Jung
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Sang Yoon Kim
- Private Practice, McLean, VA; Former Resident, Harvard Oral and Maxillofacial Surgery, Boston, MA
| | - Han-Sung Jung
- Professor, Division in Anatomy and Developmental Biology, Department of Oral Biology, Oral Science Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung-Sik Park
- Professor, Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Young-Soo Jung
- Emeritus Professor, Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, Yonsei University College of Dentistry, Seoul, Korea.
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Komori H, Kawanabe N, Kataoka T, Kato Y, Fujisawa A, Yamashiro T, Kamioka H. The different effects of intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) on mandibular border movement. Cranio 2017; 36:228-233. [PMID: 28436308 DOI: 10.1080/08869634.2017.1317899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study investigated the different effects of intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) on mandibular border movement. METHODS The participants included 22 patients receiving IVRO and 22 patients receiving SSRO who were treated at Okayama University Hospital. Their mandibular border movement was evaluated in three dimensions with 6° of freedom using an optical recording system. RESULTS A strong correlation between condylar and lower incisor movement was observed during maximum jaw protrusion and laterotrusion. Significant improvements in condylar and lower incisor movement were detected after orthognathic surgery during maximum jaw protrusion and laterotrusion in the IVRO group and during maximum jaw protrusion in the SSRO group. DISCUSSION IVRO likely achieves greater improvement in jaw movement than SSRO. Therefore, the application of IVRO could be considered in the treatment of patients with jaw deformities featuring temporomandibular joint problems.
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Affiliation(s)
- Hiroki Komori
- a Department of Orthodontics , Okayama University Hospital , Okayama , Japan
| | - Noriaki Kawanabe
- b Department of Orthodontics , Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
| | - Tomoki Kataoka
- b Department of Orthodontics , Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
| | - Yui Kato
- a Department of Orthodontics , Okayama University Hospital , Okayama , Japan
| | - Atsuro Fujisawa
- b Department of Orthodontics , Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
| | - Takashi Yamashiro
- c Department of Orthodontics and Dentofacial Orthopedics , Graduate School of Dentistry, Osaka University , Osaka , Japan
| | - Hiroshi Kamioka
- b Department of Orthodontics , Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , Okayama , Japan
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Te Veldhuis EC, Te Veldhuis AH, Bramer WM, Wolvius EB, Koudstaal MJ. The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review. Int J Oral Maxillofac Surg 2017; 46:554-563. [PMID: 28174061 DOI: 10.1016/j.ijom.2017.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/12/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The objective of this systematic review was to examine the effect of orthognathic surgery (OS) on the temporomandibular joint and oral function. Electronic databases were systematically searched for studies published until October 2015. Articles were assessed against predefined inclusion criteria. The included papers were divided into four groups based on the type of OS performed. The following items were recorded: quality of evidence using the Oxford Centre for Evidence-Based medicine (CEBM) criteria, number of patients, presence/absence of controls, mean age at treatment, follow-up time, clinical examination findings, bite force, use of the Helkimo Index and Research Diagnostic Criteria for Temporomandibular Disorders, imaging findings, and patient questionnaire results. A total of 4669 articles were identified; 76 relevant articles were included in the review. These studies assessed a total 3399 patients and 380 controls, with a mean age of 25.4 years. The great variety of OS techniques, examination techniques, diagnostic criteria, and imaging techniques used in the articles studied, as well as the quality of the study designs, made it difficult to compare studies and to draw conclusions. However, looking at the different aspects studied in general, it can be stated that OS seems to have little or no harmful effect on the TMJ and oral function (level of evidence: levels II, III, and IV).
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Affiliation(s)
- E C Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands.
| | - A H Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
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14
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Skeletal and dental stability after intraoral vertical ramus osteotomy: a long-term follow-up. Int J Oral Maxillofac Surg 2017; 46:72-79. [DOI: 10.1016/j.ijom.2016.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/08/2016] [Indexed: 11/18/2022]
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15
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Jung HD, Kim SY, Park HS, Jung YS. Orthognathic surgery and temporomandibular joint symptoms. Maxillofac Plast Reconstr Surg 2015; 37:14. [PMID: 26029683 PMCID: PMC4446569 DOI: 10.1186/s40902-015-0014-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/22/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.
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Affiliation(s)
- Hwi-Dong Jung
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Sang Yoon Kim
- Private Practice Vienna VA; Former resident Harvard Oral & Maxillofacial Surgery, Boston, MA USA
| | - Hyung-Sik Park
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Young-Soo Jung
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
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Unilateral mandibular advancement with bilateral intraoral vertical ramus osteotomy. J Craniofac Surg 2015; 26:e261-2. [PMID: 25974825 DOI: 10.1097/scs.0000000000001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intraoral vertical ramus osteotomy (IVRO) is an effective surgical procedure that is used for the correction of mandibular prognathism. However, application of IVRO for mandibular advancement has been limited because of the instability of the proximal segments caused by the gap between the distal and proximal segments. We report a case of unilateral mandibular advancement with bilateral IVRO for the correction of facial asymmetry. This case shows possible application of bilateral IVRO for unilateral mandibular advancement without any means of fixation.
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Lee JH, Park TJ, Jeon JH. Unilateral intraoral vertical ramus osteotomy and sagittal split ramus osteotomy for the treatment of asymmetric mandibles. J Korean Assoc Oral Maxillofac Surg 2015; 41:102-8. [PMID: 25922823 PMCID: PMC4411725 DOI: 10.5125/jkaoms.2015.41.2.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/11/2014] [Indexed: 11/23/2022] Open
Abstract
In surgery for facial asymmetry, mandibles can be classified into two types, rotational and translational, according to the required mandibular movements for surgery. During surgery for rotational mandibular asymmetry, a bilateral sagittal split ramus osteotomy (BSSRO) may cause a large bone gap between the proximal and distal segments as well as condylar displacement, resulting in a relapse of the temporomandibular joint disorder, especially in severe cases. The intraoral vertical ramus osteotomy has an advantage, in this respect, because it causes less rotational displacement of the proximal segment on the deviated side and even displaced or rotated condylar segments may return to their original physiologic position. Unilateral intraoral vertical ramus osteotomy (UIVRO) on the short side combined with contralateral SSRO was devised as an alternative technique to resolve the spatial problems caused by conventional SSRO in cases of severe rotational asymmetry. A series of three cases were treated with the previously suggested protocol and the follow-up period was analyzed. In serial cases, UIVRO combined with contralateral SSRO may avoid mediolateral flaring of the bone segments and condylar dislocation, and result in improved condition of the temporomandibular joint. UIVRO combined with contralateral SSRO is expected to be a useful technique for the treatment of rotational mandibular asymmetry.
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Affiliation(s)
- Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Tae-Jun Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Ju-Hong Jeon
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
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Modification of intraoral vertical ramus osteotomy. Br J Oral Maxillofac Surg 2014; 52:866-7. [DOI: 10.1016/j.bjoms.2014.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Choi YS, Jung HD, Kim SY, Park HS, Jung YS. Remodelling pattern of the ramus on submentovertex cephalographs after intraoral vertical ramus osteotomy. Br J Oral Maxillofac Surg 2013; 51:e259-62. [DOI: 10.1016/j.bjoms.2013.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/03/2013] [Indexed: 11/25/2022]
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Park KR, Kim SY, Park HS, Jung YS. Surgery-first approach on patients with temporomandibular joint disease by intraoral vertical ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e429-36. [DOI: 10.1016/j.oooo.2011.11.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 11/06/2011] [Indexed: 12/01/2022]
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21
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Jung HD, Jung YS, Kim SY, Kim DW, Park HS. Postoperative stability following bilateral intraoral vertical ramus osteotomy based on amount of setback. Br J Oral Maxillofac Surg 2013; 51:822-6. [DOI: 10.1016/j.bjoms.2013.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/04/2013] [Indexed: 11/25/2022]
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Abrahamsson C, Henrikson T, Nilner M, Sunzel B, Bondemark L, Ekberg EC. TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment. Int J Oral Maxillofac Surg 2013; 42:752-8. [DOI: 10.1016/j.ijom.2012.10.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 08/28/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
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Jung HD, Jung YS, Park JH, Park HS. Recovery Pattern of Mandibular Movement by Active Physical Therapy After Bilateral Transoral Vertical Ramus Osteotomy. J Oral Maxillofac Surg 2012; 70:e431-7. [DOI: 10.1016/j.joms.2012.02.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/03/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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