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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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Zhang X, Guo N, Cheng J, Xi W. Three-Dimensional Evaluation of Changes in Condylar Position After Orthognathic Surgery With Different Types of Jaw Deformities. J Oral Maxillofac Surg 2024:S0278-2391(24)00338-0. [PMID: 38901470 DOI: 10.1016/j.joms.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Assessing condyle position postorthognathic surgery is pivotal for optimizing surgical accuracy, sustaining postoperative stability, and ensuring predictable treatment outcomes. PURPOSE The aim of this study was to analyze the changes of condyle position after orthognathic surgery with different types of jaw deformity and to analyze whether the changes of condyle position are different. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was designed and conducted, involving adults who underwent orthognathic surgery for jaw deformities at the affiliated Stomatological Hospital of Nanchang University between 2019 and 2022. Patients with incomplete computerized tomography data were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was time (preoperative and postoperative) and types of jaw deformities (skeletal Class III, skeletal Class II, and mandibular deviation). MAIN OUTCOME VARIABLE(S) The main outcome variables were the three-dimensional linear and rotational positional changes of the condyle. COVARIATES Evaluated covariates included sex and age. ANALYSES MIMICS 20.0 software measured all data, and SPSS 22.0 software facilitated statistical analyses. Intragroup and intergroup correlation analyses employed paired t-tests and independent t-tests, with statistical significance set at P < .05. RESULTS The study sample was composed of 32 subjects with a mean age of 22.43 ± 1.6 and 9 were male. The analysis of changes of condylar position from virtual surgical planning to the immediate postoperative period showed that the maximum condylar displacement was 1.74 mm and the maximum angular change was 3.92°. The analysis of changes in condylar position from the immediate postoperative period to 1 year postoperatively showed no statistically significant changes for the same type of jaw deformity. But patients with Class II malocclusion exhibited distinct condylar displacement and rotation patterns compared to those with Class III malocclusion and mandibular deformity. CONCLUSION AND RELEVANCE The application of virtual surgical planning in orthognathic surgery ensures a high degree of consistency in achieving the desired condylar position. Moreover, no significant change in condylar position was observed after orthognathic surgery for the same type of jaw deformity. However, patients with Class II deformities exhibited a higher susceptibility to rotational displacement of the condyles compared to those with other types of jaw deformities.
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Affiliation(s)
- Xue'e Zhang
- PhD student, Resident, School of Stomatology, Jiangxi Medical College, Nanchang University Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Nan Guo
- Master student, Resident, School of Stomatology, Jiangxi Medical College, Nanchang University Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Jialong Cheng
- Master, Attending, Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University. Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China
| | - Weihong Xi
- PhD, Professor, Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Province Key Laboratory of Oral Biomedicine, Jiangxi Province Clinical Research Center for Oral Diseases, Jiangxi, China.
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Panpitakkul P, Jorns TP, Kongsomboon S, Chaichit R, Sutthiprapaporn P. Three-Dimensional Changes of Condylar Position After Bimaxillary Surgery to Correct Skeletal III Malocclusion: Cone Beam Computed Tomography Voxel-Based Superimposition Analysis. J Oral Maxillofac Surg 2024:S0278-2391(24)00339-2. [PMID: 38889883 DOI: 10.1016/j.joms.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The stability of the condylar position within the first 3 months after orthognathic surgery in patients with skeletal Class III malocclusion is crucial for subsequent orthodontic treatment. PURPOSE The purpose was to compare condylar positional changes 3 months after bimaxillary surgery to correct skeletal Class III deformities, utilizing the conventional two-dimensional combined with cone beam computed tomography voxel-based superimposition analysis. STUDY DESIGN, SETTING, SAMPLE This retrospective cohort study included skeletal Class III patients undergoing bimaxillary orthognathic surgery at Khon Kaen University, Thailand, in 2020. Exclusion criteria were patients with temporomandibular disorder symptoms, facial asymmetry prior to the surgery, or surgical complications. EXPOSURE VARIABLE The exposure variable was the timing, both preoperatively and 3 months postoperatively. This 3-month postoperative time point was chosen because complete healing of the bimaxillary surgery is expected by then, without any potential influence of condylar changes resulting from subsequent orthodontic treatment. MAIN OUTCOME VARIABLES The outcome variables are condylar position measurement, joint space (mm), and axial condylar angle (degrees). COVARIATES Demographics (age, sex) and surgical details (direction and amount of movement) were collected as covariates. ANALYSES Statistical analysis of condylar positional changes and correlations was performed using paired t-test and linear correlation (P value < .05), respectively. RESULTS The sample included 11 subjects (22 condyles), with a mean age of 24 ± 5.24 years. Both two-dimensional measurements and voxel-based three-dimensional superimposition showed significant changes in condylar position 3 months after bimaxillary surgery: inferior (0.45 ± 0.26 mm, P < .001), posterior (0.46 ± 0.39 mm, P = .003), lateral (0.38 ± 0.42 mm, P = .01) displacement, and inward rotation (5.21 ± 2.54°, P < .001). No significant correlation was found between jaw movement distance and condylar changes. CONCLUSION AND RELEVANCE To our knowledge, this is the first study to report measures of condylar changes at 3 months, when complete healing of the osteotomies would be expected, using Le Fort I osteotomy for maxillary advancement combined with bilateral sagittal split ramus osteotomy for mandibular setback. These changes are small in magnitude and may be of little relevance to patient care.
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Affiliation(s)
- Panjaree Panpitakkul
- Postgraduate Student, Division of Orthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Teekayu Plangkoon Jorns
- Associate Professor, Division of Oral Biology, Department of Oral Biomedical Science, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Supaporn Kongsomboon
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Rajda Chaichit
- Assistant Professor, Division of Dental Public Health, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Pipop Sutthiprapaporn
- Associate Professor, Division of Orthodontics, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
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Shi Y, Guo S, Wang H, Yao Q, Wang D, Cheng J. The top 100 highly cited articles on surgery-first orthognathic surgery between 2009 and 2022: a bibliometric and visualized analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:463-475. [PMID: 38480068 DOI: 10.1016/j.oooo.2023.12.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 06/19/2024]
Abstract
OBJECTIVES To reveal research focuses on surgery-first orthognathic surgery by a bibliometric and visualized analysis of the top 100 highly cited articles. STUDY DESIGN Published papers related to surgery-first orthognathic surgery were retrospectively retrieved from the Web of Science Core Collection from 2009 to 2022. The number of articles, journals, countries/regions, institutions, authors, and keywords were assessed and visualized using CiteSpace software. RESULTS The top 100 cited articles included 89 research papers and 11 reviews. The average total citation was 21. The most influential article with 146 citations was published by Dr. Liou E.J.W. in 2011. The most common level of evidence was level IV (36 articles). The Journal of Oral and Maxillofacial Surgery had the largest number of papers and the highest total citation frequency. The most productive countries and institutions were Korea/China and Chang Gung Memorial Hospital, respectively. Chen Yu-ray and Choi Jong Woo published 13 and 11 articles with 434 and 299 total citations, respectively. Research interests shifted from skeletal class III malocclusion, accuracy, stability, and relapse to quality of life and virtual surgical planning. CONCLUSION Our bibliometric analyses provide a comprehensive landscape of the influential topics and developmental trends in surgery-first orthognathic surgery and inspire future studies in this booming field.
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Affiliation(s)
- Yijin Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, China; Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China
| | - Songsong Guo
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, China
| | - Hong Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, China
| | - Qin Yao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, China
| | - Dongmiao Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, China; Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China.
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Thongngam T, Srimaneekarn N, Sirintawat N, Kasemsarn W. Relationship of the Degree of Nerve Exposure and Surgical Manipulation and Short-Term Neurosensory Disturbance Following Sagittal Split Ramus Osteotomy: A Prospective Study. J Oral Maxillofac Surg 2024; 82:159-168. [PMID: 37989495 DOI: 10.1016/j.joms.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Neurosensory disturbance (NSD) is a common complication after sagittal split ramus osteotomy (SSRO) due to inferior alveolar nerve (IAN) injury. The impact of intraoperative nerve manipulation on NSD remains debated. PURPOSE The purpose of this study was to evaluate the influence of IAN exposure and manipulation during SSRO on functional sensory recovery (FSR). STUDY DESIGN This was a single-center, prospective cohort study of 40 patients undergoing SSRO at Mahidol University from December 2020 to December 2021. The inclusion criteria were patients aged 20-34, ASA Class I-II. The exclusion criteria were patients with systemic bone disease, history of head and neck or neurological pathology, previous SSRO, or incomplete data collection. PREDICTOR VARIABLE Degree of intraoperative nerve manipulation was divided by the attending surgeon as follows; 1) Nerve fully encased in distal segment and not visible (NS); 2) Nerve encased in distal segment but partially visible (DS); and 3) Nerve partially encased in proximal segment and fully dissected free (PS). OUTCOME VARIABLES The area of interest was divided into the lip and chin. The primary outcome was time to FSR. The secondary outcome was subjective patient report, using a visual analogue scale, compared to FSR. COVARIATES The covariates were sex, age, skeletal diagnosis, degree of movement, and concomitant genioplasty/subapical procedure. ANALYSES Kaplan-Meier survival analysis, Cox proportional hazards regression, and Mcnemar test were utilized. P-value < .05 was significant. RESULTS In the lip, the median times to FSR were NS, 2 days; DS, 45 days; PS, 102 days. (Interquartile range: 77,127, 114, respectively) In the chin, the median times to FSR were NS, 23 days; DS, 92 days; PS, 87 days. (Interquartile range: 77, 161, 101, respectively.) Nerve manipulation significantly affected FSR in the lip and chin (P = .001, <0.001, respectively. Cox hazard ratios for DS and PS were lower compared to NS. Patients consistently reported more NSD compared to FSR as per Mcnemar test. CONCLUSION AND RELEVANCE After SSRO, FSR in the lip is prolonged when the IAN is partially encased in the proximal segment and released. This raises the question of the efficacy of surgically releasing a partially encased IAN.
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Affiliation(s)
- Tanutchaporn Thongngam
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natchalee Srimaneekarn
- Associate Professor, Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Warutta Kasemsarn
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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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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Feng Y, Teng H, Shu J, Shao B, Chong DYR, Liu Z. Biomechanical comparison of the effect of bilateral sagittal split ramus osteotomy with or without Le Fort I osteotomy on the temporomandibular joints of the patients with maxillofacial deformities under centric occlusion. Comput Methods Biomech Biomed Engin 2023; 26:1732-1741. [PMID: 36322673 DOI: 10.1080/10255842.2022.2138707] [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: 06/08/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
Mandibular deformities negatively affect the daily activities of the patients and may cause temporomandibular disorders (TMD). Bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I osteotomy are effective treatments to correct the mandibular deformities. The aim of this study was to investigate and compare the effects of the BSSRO with or without Le Fort I on the stress distributions of the temporomandibular joints (TMJs) of the patients with mandibular deformities under centric occlusion based on finite element (FE) method. Preoperative and postoperative cone-beam computed tomography (CBCT) images of twenty-four patients diagnosed with mandibular prognathism, including ten patients with BSSRO and another 14 patients with bimaxillary osteotomy (BSSRO with Le Fort I), were used to construct maxillofacial models. Ten asymptomatic individuals were also performed CBCT scanning and defined as the control group. In addition, the muscle forces and boundary conditions corresponding to centric occlusions were applied on each model. For the preoperative groups with both the BSSRO and bimaxillary osteotomies, the average peak contact stresses of the TMJs were both greater than those of the control group. After the surgeries, the contact stresses of the discs and temporal bones of both groups considerably decreased. However, the contact stresses on the condyles slightly increased after BSSRO but decreased after bimaxillary osteotomy. The TMJs of the patients with maxillofacial deformities suffered abnormal tensile and compressive stresses compared with the asymptomatic subjects under centric occlusion. Both of the BSSRO and bimaxillary osteotomy could improve the risk stress distributions of the TMJs.
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Affiliation(s)
- Yukai Feng
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China
| | - Haidong Teng
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China
| | - Jingheng Shu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China
| | - Bingmei Shao
- Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China
- Basic Mechanics Lab, Sichuan University, Chengdu, China
| | - Desmond Y R Chong
- Engineering Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China
- Sichuan University Yibin Park, Yibin Institute of Industrial Technology, Yibin, China
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Ren R, Li Y, Telha W, Zhu S, Jiang N. Effect of the magnitude of condylar head displacement on the TMJ function in skeletal class II patients undergoing different degrees of mandibular advancement: A retrospective comparative study. J Plast Reconstr Aesthet Surg 2023; 84:241-249. [PMID: 37352620 DOI: 10.1016/j.bjps.2023.06.001] [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: 12/14/2022] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE This study aimed to compare the condylar head displacement (CHD) after bilateral sagittal split ramus osteotomy (BSSO) between different degrees of mandibular advancement in skeletal class II patients and to evaluate whether the temporomandibular joint (TMJ) function would be affected. PATIENTS AND METHODS Fifty-nine patients (118 condyles) were included in this retrospective study and were divided into three groups based on the distance of mandibular advancement. The CHD in three directions, x (sagittal direction), y (coronal direction), and z (axial direction), was measured before operation (T0), immediately after operation (T1), and at least 6 months after operation (T2), and the TMJ function of patients was followed up and scored using the Helkimo index system. All the abovementioned data were statistically analyzed, and p < 0.05 was considered the statistical difference standard. RESULT During the BSSO surgery, the condyle was predominantly displaced in a lateral, posterior, and superior direction whenever in T1 and T2, even though the degree of CHD was different. Regarding the amount of CHD, the large advancement group was higher than the other two groups in T1 and T2 (p<0.01). The Helkimo index scores of the three groups were evaluated, and there was no significant statistical difference between the Ai and Di index of the three groups. CONCLUSION In our center, CHD occurred in lateral, posterior, and superior directions following mandibular advancement in skeletal class II patients, with a positive correlation between the CHD and the mandibular advancement; however, the TMJ function of the three groups did not show significant differences.
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Affiliation(s)
- Rong Ren
- 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, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Yibo Li
- 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, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Wael Telha
- 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, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China
| | - Songsong Zhu
- 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, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China.
| | - Nan Jiang
- 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, No. 14, Section 3 of Renmin Nan Road, Chengdu 610041, Sichuan, China.
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BSSRO Improves Mandibular Morphology Mainly through Correction of Body Length and Volume in Patients with Asymmetric Mandibular Prognathism. J Clin Med 2022; 11:jcm11237131. [PMID: 36498704 PMCID: PMC9741447 DOI: 10.3390/jcm11237131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: The purpose of this study is to analyze the change and stability of mandibular morphology in patients with asymmetric mandibular prognathism after bilateral sagittal split ramus osteotomy (BSSRO). Methods: We retrospectively analyzed fifty patients with asymmetric mandibular prognathism from the West China Hospital of Stomatology, Sichuan University, between January 2018 to March 2021. The spiral CT data before surgery, within two weeks after surgery, and at more than six months after surgery of each patient were collected. According to the deflection direction of the chin, the bilateral mandibles were defined as the long side and the short side. The morphological data of the bilateral condyle, the mandibular ramus, and the mandibular body were analyzed to determine the effect and stability of BSSRO on asymmetric mandibular prognathism. Results: It was found that the long-side mandible had greater condylar volume and diameter, mandibular ramus height and volume, and mandibular body length and volume (p < 0.05) before surgery. After surgery, the volume of the mandibular ramus increased, while the length and volume of the mandibular body decreased (p < 0.05) at the long side of the mandible; the morphological changes of the mandibular ramus and body at the short side of the mandible were not statistically significant (p > 0.05). When comparing the long and short sides of the mandible, the long side still had greater height and volume of the mandibular ramus (p < 0.01). The volume difference of the mandibular body from the two sides was corrected (p > 0.05), and the length difference of the mandibular body from the two sides was overcorrected (p < 0.05). At more than six months after surgery, the volume of the mandibular ramus and body increased, while their height decreased at the long side of the mandible (p < 0.05). For the other side, or the short side, the volume of the ramus and body increased, too. However, their height decreased (p < 0.01). Conclusion: The results of this study suggested good effect and stability of BSSRO on asymmetric mandibular prognathism, except for the correction of ramus height and volume.
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Barone S, Muraca D, Averta F, Diodati F, Giudice A. Qualitative and quantitative assessment of condylar displacement after orthognathic surgery: A voxel-based three-dimensional analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:685-690. [PMID: 34763135 DOI: 10.1016/j.jormas.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/17/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to evaluate the morphometric changes in the position of the mandibular condyles before and after orthognathic surgery. METHODS A retrospective single-center cohort study was conducted and included patients with a presurgical (T1) and postsurgical (T2) Cone Beam computed tomography (CBCT). The primary predictor variable was the orthognathic surgical treatment. Pre-operative and post-operative CBCT scans were superimposed using voxel-based registration. Semitransparent overlays of the models of condylar regions at T1 and T2 were created for the qualitative analysis. The primary outcome variable was the quantitative displacement of condyles (CoR; CoL) analyzed in X, Y, Z axis and the 3D distances. Descriptive and bivariate statistical analysis was performed, setting α=0.05. RESULTS The study sample included 33 patients (mean age: 25.33±2.49 years) affected by skeletal class III malocclusion with or without skeletal asymmetry. The X-axis showed a mean movement of 0.25 ± 0.17 mm for CoR, and 0.52 ± 0.51 mm for CoL. The Y-axis showed a mean movement of 0.29 ± 0.2 mm for CoR, and 0.51 ± 0.8 mm for CoL. The Z-axis was 0.33 ± 0.2 mm for CoR, and 0.5 ± 0.49 mm for CoL. No statistically significant difference was calculated comparing the movement of condylar surface between asymmetric and not asymmetric patients (p = 0.26 for CoR; p = 0.13 for CoL). No statistically significant difference was found in intercondylar distance between T1 and T2 (p = 0.39). CONCLUSION No statistically nor clinically significant condylar displacement are recorded in orthognathic surgery patients at 12 to 18 months of follow-up.
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Affiliation(s)
- Selene Barone
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Danila Muraca
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Fiorella Averta
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Federica Diodati
- School of Dentistry, Department of Health Sciences, Magna Graecia, University of Catanzaro, Viale Europa 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Oral and Maxillofacial Surgeon, Professor, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa 88100 Catanzaro, Italy.
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Orofacial myofunctional changes in skeletal Class III patients after bimaxillary orthognathic surgery. J Plast Reconstr Aesthet Surg 2022; 75:3526-3533. [DOI: 10.1016/j.bjps.2022.04.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022]
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Three-dimensional condylar displacement and remodelling following correction of asymmetric mandibular prognathism with maxillary canting. Int J Oral Maxillofac Surg 2021; 51:813-822. [PMID: 34924271 DOI: 10.1016/j.ijom.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/11/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023]
Abstract
The aim of this study was to investigate the three-dimensional condylar displacement and long-term remodelling following the correction of asymmetric mandibular prognathism with maxillary canting. Thirty consecutive patients (60 condyles) with asymmetric mandibular prognathism >4 mm and occlusal canting >3 mm, treated by Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included. Spiral computed tomography scans obtained at different periods during long-term follow-up (mean 17 ± 7.2 months) were gathered and processed using ITK-SNAP and 3D Slicer. The condyles were subjected to translational and rotational displacements immediately after the surgery (T2), which had not fully returned to the original preoperative positions at the last follow-up (T3). Condylar remodelling was observed at the last follow-up (T3), with the shorter side condyles subjected to higher surface resorption and overall condylar volume loss. The overall condylar volume on the shorter side was significantly reduced compared to the volume on the elongated side (-11.9 ± 90.6 vs -131.7 ± 138.2 mm3; P = 0.001). About 73%, 87%, 53%, and 54% of the shorter side condyles experienced resorption on the posterior, superior, medial, and lateral surfaces, respectively; in contrast, only 50% of the elongated side condyles showed resorption on the superior surface. Higher preoperative asymmetry was significantly correlated with increased postoperative condylar displacement (P < 0.05). The vertical asymmetry and the vector of condylar displacement were associated with the resultant remodelling process. It is concluded that condylar resorption of the shorter side condyle, which may affect the long-term surgical stability, has to be considered.
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Abotaleb BM, Bi R, Liu Y, Jiang N, Telha W, Zhu S. Three-dimensional condylar displacement and remodelling in patients with asymmetrical mandibular prognathism following bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2021; 51:509-517. [PMID: 34446294 DOI: 10.1016/j.ijom.2021.08.008] [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: 12/08/2020] [Revised: 05/25/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
This study aims to assess the postoperative condylar displacement and the long-term condylar remodelling in patients with mandibular prognathism with transverse asymmetry after bilateral sagittal split ramus osteotomy (BSSRO). Forty-one consecutive patients (82 condyles) with a transverse mandibular asymmetry of more than 4 mm without occlusal canting treated by BSSRO were included. The preoperative (T1), immediate postoperative (T2) and long-term follow-up of an average of 16.2 months (T3) spiral computed tomography scans were gathered and processed to measure the condylar displacement and remodelling based on cranial base voxel-based and rigid regional registrations. The statistical analysis revealed that the majority of condyles (T1-T2) were transitionally displaced forwards, downwards and laterally, and were not fully returned to the preoperative position at T3. Condylar lateral displacement was significantly higher on the deviated side (DS) (P = 0.035). Non-deviated side (NDS) condyles were mainly subjected to upward pitch, medial yaw and medial roll compared with downward pitch, lateral yaw and lateral roll on DS. Condylar remodelling at T3 was observed, with the superior and posterior surfaces commonly subjected to bone resorption, whereas the anterior and medial surfaces were commonly subjected to bone apposition. Condylar volumetric changes were relatively comparable on NDS (3 ± 85.2 mm3) and DS (8.3 ± 111.7 mm3) condyles. Age, amount of preoperative asymmetry and follow-up period were not correlated with the condylar remodelling. Transitional and rotational displacements were to some extent significantly correlated with the condylar remodelling on both sides. Consequently, passive condylar seating without torque might prevent the long-term unfavourable condylar remodelling.
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Affiliation(s)
- B M Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - R Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Y Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - N Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - W Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - S Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Changes in Condylar Position Within 12 Months After Bilateral Sagittal Split Ramus Osteotomy With and Without Le Fort I Osteotomy by Using Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2021; 80:162-173. [PMID: 34547267 DOI: 10.1016/j.joms.2021.08.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to evaluate the condylar position changes in 12 months after bilateral sagittal split ramus osteotomy (BSSO) with and without a Le Fort I osteotomy in patients with Class III malocclusion and the influence of the 2 surgical approaches on the condylar position. METHODS In this prospective cohort study, patients with skeletal Class III malocclusion who underwent orthognathic surgery between 2017 and 2019 were included. The main predictive variable is the effect of increasing Le Fort I osteotomy on condyle position, which is divided into BSSO-only group and BSSO + Le Fort I osteotomy group. The main outcome variables were the displacement of the condylar head and the rotation/inclination of the condylar long axis before and after surgery. Other study variables were according to the degree of asymmetry of the left and right side of the mandible, the measured values of both sides were divided into mandibular deviation and nondeviation. The cone-beam volumetric imaging images were obtained before surgery (T1) and immediately after surgery (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after surgery by computerized tomography (CT). One-way ANOVA and Tukey test was used for correlation analysis. The p-value is set to 0.05. RESULTS Twenty-four adult patients diagnosed with skeletal Class III malocclusion were included in this study, 12 patients (male/female = 6:6, mean age 21.8 years) who underwent BSSO + Le Fort I osteotomy and 12 patients (male/female = 6:6, mean age 19.8 years) who underwent BSSO-only. The position of the bilateral condylar head in both surgery groups was adjusted continuously during the 12 months after the operation. Immediately and 12 months after surgery, both sides of the condylar long axis in the BSSO with Le Fort I osteotomy group and the BSSO-only surgery group rotated inward, tilted forward, and tilted inward. In the BSSO with Le Fort I osteotomy group, the rotation and tilt angle changes of the condylar long axis on both sides were stable 6 months after surgery. CONCLUSIONS The addition of Le Fort I osteotomy did not significantly change the rotation and tilt direction of the condylar long axis and could accelerate the stability of the condylar long axis after BSSO surgery.
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Lai C, Song G, Zong X, Jin X. Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians. Aesthetic Plast Surg 2021; 45:1564-1572. [PMID: 33616716 DOI: 10.1007/s00266-021-02181-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony. METHODS Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD. RESULTS Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness. CONCLUSIONS This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour. LEVEL OF EVIDENCE IV 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)
- Chenzhi Lai
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Guodong Song
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Xianlei Zong
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Xiaolei Jin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33 Badachu Road, Shijingshan District, Beijing, People's Republic of China.
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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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Analysis of Sagittal Position Changes of the Condyle After Mandibular Setback Surgery Across the Four Different Types of Plating Systems. J Craniofac Surg 2021; 32:2441-2445. [PMID: 33710053 PMCID: PMC8478309 DOI: 10.1097/scs.0000000000007578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The authors analyzed the three-dimensional postoperative condylar position change across the plating systems. This retrospective study was conducted with the patients who underwent bilateral sagittal split ramus osteotomy with setback surgery. The condylar change was analyzed from preoperative cone-beam computed tomography to postoperative 1 month (T1) and postoperative 6 months (T2) using superimposition software, automatically merging based on the anterior cranial base. The condylar changes during T1 and T2 were analyzed across the four types of plates (4-hole sliding, heart-shaped, 3-hole sliding, and 4-hole conventional) Mean intraclass correlation coefficient values were consistently high for each measurement (>0.850). During T1, the conventional plate had a decreased condylar anterior distance when compared with the 3-hole sliding plate (P = 0.032). During T2, the conventional plate had an increased condylar posterior distance when compared with the 3-hole sliding plate (P = 0.031). Superimposition software based on the anterior cranial base could be available for measurement of condylar position with highly reproducible results. After bilateral sagittal split ramus osteotomy, the 3-hole sliding plate could effectively compensate for the anterior displacement of the condyle compared to other plates.
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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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Hosseinzadeh Nik T, Gholamrezaei E, Keshvad MA. Facial asymmetry correction: From conventional orthognathic treatment to surgery-first approach. J Dent Res Dent Clin Dent Prospects 2019; 13:311-320. [PMID: 32190216 PMCID: PMC7072083 DOI: 10.15171/joddd.2019.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The surgery-first approach (SFA), which proceeds without presurgical orthodontic treatment, is assumed to shorten the treatment course because the direction of post-surgical orthodontic tooth movement conforms to the normal muscular forces.
Moreover, the regional acceleratory phenomenon (RAP), evoked by surgery, helps in tooth alignment and compensation in a
faster way. Although SFA has definite advantages, especially in class III individuals, there is a lack of data about its indications
in patients with facial asymmetry. In this article, we reviewed recently published articles on the treatment of asymmetric
patients using the SFA. Different aspects, including the three-dimensional assessment of stability in different planes, approaches for fabrication of a surgical splint, predictability of the results, skills needed for bimaxillary surgery, indications as
the treatment of choice for condylar hyperplasia, and combination with distraction osteogenesis in candidates with severe
asymmetries were found to be the main topics discussed for patients presenting with facial asymmetry
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Affiliation(s)
- Tahereh Hosseinzadeh Nik
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Gholamrezaei
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Keshvad
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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