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Turgut Altay H, Ertem SY. The Stress Effects of Mandibular Movements on the Temporomandibular Joint With Sagittal Split Ramus Osteotomy. J Craniofac Surg 2024:00001665-990000000-02005. [PMID: 39360968 DOI: 10.1097/scs.0000000000010712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 09/09/2024] [Indexed: 10/05/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the stress changes in the temporomandibular joint (TMJ) after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA). MATERIAL AND METHODS 5 and 10 mm mandibular setback and advancement were applied to models by using SSRO and a control model without osteotomy evaluated. The articular disc was modeled as superelastic, and the stresses on the articular fossa, disc, and condyle were evaluated. RESULTS The stresses on the cartilage were 1.150 MPa on the 5 mm advancement model and 1.506 MPa on the 10 mm advancement model. The stresses on the disc were 11.56 MPa on the 5 mm advancement model, 7.94 MPa on the 10 mm advancement model and the amount were significantly higher than other models. The stress, especially in the cartilage, increased with the amount of advancement. In the setback models, the stresses on the condylar cartilage and the disc were higher than in the control model, and the stress in the condylar cartilage increased with the amount of setback. CONCLUSION SSRO increases the stresses in the TMJ components and stresses increase depending on the amount of advancement and setback and may cause the development of joint problems.
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Affiliation(s)
- Hilal Turgut Altay
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Ankara Yildirim Beyazit University, Ankara, Turkey
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2
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Ângelo DF, Faria-Teixeira MC, Maffia F, Sanz D, Sarkis M, Marques R, Mota B, João RS, Cardoso HJ. Association of Malocclusion with Temporomandibular Disorders: A Cross-Sectional Study. J Clin Med 2024; 13:4909. [PMID: 39201051 PMCID: PMC11355311 DOI: 10.3390/jcm13164909] [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: 07/29/2024] [Revised: 08/12/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Temporomandibular disorders (TMD) encompass a range of musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ) and associated structures. This cross-sectional study, conducted in a Portuguese TMD department, aimed to assess the relationship between malocclusion and TMD severity. Methods: Data on demographic variables, TMD clinical symptoms, and malocclusion classes were collected using the EUROTMJ database. The Chi-square test (χ2) identified associations, with their intensity measured by Cramér's V (φc). Results: The study included 1170 patients (932 females and 238 males), with a mean age of 41.73 ± 16.80 years. Most patients exhibited Angle Class I malocclusion (85.5%), followed by Angle Class II (13.5%) and Angle Class III (1.1%). Class II malocclusion was associated with increased TMD severity (p < 0.001), higher myalgia levels (p = 0.002), more frequent disc displacement without reduction (p = 0.002) and lower maximum mouth opening values (Class II: 38.13 ± 7.78 mm, Class I: 39.93 ± 8.67 mm). Significant associations were also found between malocclusion type and arthralgia (p = 0.021), mouth-opening limitation (p = 0.016), and TMJ crepitus (p = 0.017). In cases of malocclusion, the presence of oral signs of bruxism explained the degree of myalgia, disc displacement, and severity (p = 0.003; p = 0.048; p = 0.045). Conclusions: This study highlights that (1) the most common type of dental malocclusion in TMD patients was Class I; (2) Class II malocclusion was associated with increased TMD severity and oral signs of bruxism; and (3) Class III was rarely observed in TMD consultation. The findings suggest that bruxism behavior in cases of malocclusion may be significant in TMD.
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Affiliation(s)
- David Faustino Ângelo
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal
- Faculty of Medicine, Lisboa University, 1649-028 Lisbon, Portugal
- Serviço de Estomatologia Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1349-019 Lisbon, Portugal
- Centro Hospitalar Universitário Lisboa Norte (CHUNL), Clinica Universitária de Estomatologia, 1648-028 Lisbon, Portugal
| | | | - Francesco Maffia
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
| | - David Sanz
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
| | - Marcella Sarkis
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
| | - Rute Marques
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
| | - Beatriz Mota
- Instituto Português da Face, 1500-493 Lisbon, Portugal; (F.M.); (B.M.)
- Centro Hospitalar Universitário Lisboa Norte (CHUNL), Clinica Universitária de Estomatologia, 1648-028 Lisbon, Portugal
| | - Ricardo São João
- Department of Computer Science and Quantitative Methods, School of Management and Technology, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal
- CEAUL—Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal
- Center for Global Studies (CEG-UAb), Aberta University, 1250-100 Lisbon, Portugal
- Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), 1600-190 Lisbon, Portugal
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Takaoka R, Morioka S, Ueda Y, Tsunetou Y, Baba H, Ishigaki S. Changes in occlusal relationships observed using an intraoral scanner in patients with an acquired open bite: A case report. J Prosthodont Res 2024; 68:487-492. [PMID: 38281760 DOI: 10.2186/jpr.jpr_d_23_00146] [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] [Indexed: 01/30/2024]
Abstract
PATIENTS This case report describes a procedure for assessing changes in occlusal relationships in patients with acquired open bites due to temporomandibular joint disease using an intraoral scanner (IOS). A digital impression was made using the IOS at the initial visit. Subsequent impressions were made every 6 months using the IOS and magnetic resonance imaging (MRI) or computed tomography (CT). Standard triangulated language (STL) image files of two digital impressions at different points in time were superimposed, including the occlusal relationship with reference to the maxillary dentition. Finally, three-dimensional (3D) changes in the occlusal relationship over time were evaluated. DISCUSSION In Case 1, the superimposed STL image indicated almost no evident deviation of the mandible. Therefore, an orthodontic treatment was initiated. In contrast, in cases 2 and 3, where changes in the occlusal relationship continued, secondary treatment was postponed and patients continued to be monitored periodically. In case 3, even though left condyle resorption was progressive, the degree of open bite on the right side improved after 6 months. However, the open bite continued to progress for another 6 months despite the stability of the condyle. CONCLUSIONS Changes in the condylar shape observed using imaging may not always reflect changes in the occlusal relationship. In addition to changes in the condyles and eminences of the temporomandibular joint (TMJ), changes in the occlusal relationships of patients with acquired open bite should be evaluated using an intraoral scanner.
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Affiliation(s)
- Ryota Takaoka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shion Morioka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - You Ueda
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Yohei Tsunetou
- Osaka University Dental Hospital Dental Laboratory, Suita, Japan
| | - Hirotaka Baba
- Osaka University Dental Hospital Dental Laboratory, Suita, Japan
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
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Tanaka E, Mercuri LG. Current Status of the Management of Idiopathic Condylar Resorption/Progressive Condylar Resorption-A Scoping Review. J Clin Med 2024; 13:3951. [PMID: 38999512 PMCID: PMC11242904 DOI: 10.3390/jcm13133951] [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: 06/19/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
The temporomandibular joint (TMJ) is a complex synovial joint shrouded in mystery, as the etiology of many TMJ disorders are unsolved. Idiopathic/progressive condylar resorption (ICR/PCR) is one such TMJ disorder characterized by a gradually deteriorating mandibular condylar mass, resulting in severe mandibular retrognathia, which often accompanied by clockwise rotation of mandible and an anterior open bite. Since the etiology of the ICR/PCR remains unclear, no definitive prevention or management options have been established. To date, various symptomatic non-surgical, surgical, and salvage management options have been developed and reported. To understand the current status of the ICR/PCR management options, this article provides an overview of the options presently reported in the literature to reduce its TMJ symptoms and improve mandibular function and form.
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Affiliation(s)
- Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8504, Japan
| | - Louis G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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DeLeonibus A, Bogart J, Gharb BB, Rampazzo A. Orthognathic Surgery in Ehlers-Danlos Syndrome: Review of the Literature and Case Report. Cleft Palate Craniofac J 2024; 61:1061-1070. [PMID: 36683425 DOI: 10.1177/10556656231152632] [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] [Indexed: 01/24/2023] Open
Abstract
EDS (Ehlers-Danlos Syndrome) is a heterogenous group of inheritable connective tissue disorders that commonly precludes patients from being elective surgical candidates. Patients with EDS are at a higher risk of increased bleeding, delayed wound healing, and temporomandibular joint pain refractory to treatment. Historically, patients with EDS and TMJ disorders are considered inappropriate surgical candidates due to a higher risk of delayed wound healing, increased risk for uncontrolled post-surgical bleeding, and unsubstantiated outcomes in regards to elective orthognathic surgery. A review of the literature demonstrates a paucity of data accounting the use of orthognathic surgery and maxillary-mandibular advancement in patients with EDS. The present study reports on the use of orthognathic double jaw surgery in a patient with a known diagnosis of hypermobile EDS, history of TMJ subluxation and pain. This case describes a 47-year-old woman with a history of hypermobile EDS who presented with Angle Class II malocclusion, Class II skeletal pattern, and clockwise rotation of the occlusal plane associated with pain at the bilateral TMJs. She underwent maxillary-mandibular advancement with counterclockwise rotation of the occlusal plane and genioplasty. The surgery was without complications, and at 22 months follow up, the patient healed uneventfully with improvement of pain and range of motion. This case report demonstrates that with diligent patient selection, orthognathic surgery in patients with EDS can be safe and effective and should not be an absolute contraindication.
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Affiliation(s)
- Anthony DeLeonibus
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joseph Bogart
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bahar Bassiri Gharb
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Antonio Rampazzo
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kariya C, Kanzaki H, Kumazawa M, Sahara S, Yoshida K, Inagawa Y, Kobayashi F, Tomonari H. Skeletal Anterior Open Bite Attenuates the Chewing-Related Increase in Brain Blood Flow. Dent J (Basel) 2024; 12:161. [PMID: 38920862 PMCID: PMC11202511 DOI: 10.3390/dj12060161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
The masticatory function of patients with skeletal anterior open bite (OPEN) is reported to be impaired compared with that of patients with normal occlusion (NORM). In this study, we compared brain blood flow (BBF) in patients with OPEN and NORM and investigated the factors related to BBF during mastication in patients with OPEN. The study included 17 individuals with NORM and 33 patients with OPEN. The following data were collected: number of occlusal contacts, jaw movement variables during mastication, and BBF measured with functional near-infrared spectroscopy during chewing. The number of occlusal contacts, maximum closing and opening speeds, closing angle, and vertical amplitude were smaller in the OPEN than in the NORM group. Interestingly, BBF increased less in the OPEN group. Correlation analysis revealed that several parameters, including number of occlusal contacts and closing angle, were correlated with changes in BBF during mastication. These results suggest that not only occlusion but also jaw movement variables and factors related to masticatory muscles contribute to the chewing-related increase in BBF. In conclusion, BBF increases less during mastication in patients with OPEN than in those with NORM. In addition, the higher increase in BBF is correlated with jaw movement. Together, we discovered that OPEN exhibits significant adverse effects not only on masticatory function but also on brain function.
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Affiliation(s)
| | - Hiroyuki Kanzaki
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (C.K.); (M.K.); (S.S.); (K.Y.); (Y.I.); (F.K.); (H.T.)
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Luo S, Guo S, Shi Y, Wang H, Zhang P, Jiang H, Cheng J. Comprehensive 3-dimensional Positional and Morphological Analyses of Condyle and Glenoid Fossa in Patients with Skeletal Class II Malocclusion following Bimaxillary Orthognathic Surgery. J Craniofac Surg 2024:00001665-990000000-01527. [PMID: 38710064 DOI: 10.1097/scs.0000000000010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/17/2024] [Indexed: 05/08/2024] Open
Abstract
This study aimed to comprehensively and quantitatively characterize 3-dimensional (3D) positional and morphological changes of the condyle and glenoid fossa in patients with skeletal Class II malocclusion treated with bimaxillary orthognathic surgery. Twenty eligible patients treated at our institution from January 2016 to December 2021 with more than 12 months of postoperative follow-up were retrospectively enrolled. Radiographic data of cone-beam computed tomography (CBCT) for each patient were collected at 3 stages: 1 week preoperatively (T0), immediately after surgery (T1), and at least 12 months postoperatively (T2). Positional changes, surface and volumetric alterations of condyle, and bone remodeling in glenoid fossa were measured and compared based on voxel- and surface registrations in visual 3D methods. Most patients exhibited a tendency for condyles to shift posteriorly, laterally, superiorly, and rotated outward, downward, and forward immediately after surgery. Posterior, medial, superior movement and outward, upward, and backward rotation of condyles were observed during follow-up (T1-T2). Bone resorption frequently occurred in the posterior area of condylar surfaces, while bone remodeling was more common in the anterior region of the glenoid fossa. Reduced volume of the condyle was found in most cases, which was not associated with the amount of mandibular advancement. Overall, the condyle and its corresponding glenoid fossa remained relatively stable during the follow-up. Our results reveal positional and morphological alterations in the condyle and the glenoid fossa after bimaxillary orthognathic surgery in patients with skeletal class II malocclusion. These changes predominantly fall within the spectrum of physical adaption.
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Affiliation(s)
- Si Luo
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital
| | - Songsong Guo
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital
| | - Yijin Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital
| | - Hong Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital
| | - Ping Zhang
- Jiangsu Key Laboratory of Oral Disease
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China
| | - Hongbing Jiang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital
- Jiangsu Key Laboratory of Oral Disease
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital
- Jiangsu Key Laboratory of Oral Disease
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China
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Li J, Shujaat S, Ver Berne J, Shaheen E, Coucke W, Politis C, Jacobs R. Postoperative complications following orthognathic surgery in patients with rheumatic diseases: A 2-year follow-up study. Oral Dis 2024; 30:586-592. [PMID: 36301158 DOI: 10.1111/odi.14417] [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: 06/23/2022] [Revised: 10/06/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the complications following orthognathic surgery in patients with rheumatic diseases and to evaluate rheumatic disease as a possible risk factor. METHODS A retrospective cohort study was conducted during a 6-year period. The sample consisted of rheumatic and healthy patients who underwent orthognathic surgery. The outcome variables included infection, relapse, respiratory complications, hemorrhage, neurosensory disturbances, temporomandibular joint complications, and removal of osteosynthesis material. Bivariate analysis and logistic regression were applied to identify rheumatic disease as an independent risk factor for complications after orthognathic surgery. RESULTS Twenty patients were identified as having rheumatic diseases (male: 2; female: 18; mean age: 37.8 ± 13.6 years), and 278 patients were systemically healthy (male: 105; female: 173; mean age: 25.8 ± 11.8 years). The most frequent complications in rheumatic and healthy patients were delayed recovery from neurosensory disturbance (55% and 33%), removal of osteosynthesis material (45% and 26%), and infection (35% and 7%). Following adjustment for possible confounders, rheumatic disease showed a significant association with infection (OR = 4.191, p = 0.016). CONCLUSION Patients with rheumatic diseases are at a higher risk of postoperative infection following orthognathic surgery compared to healthy patients.
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Affiliation(s)
- Jiqing Li
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jonas Ver Berne
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Freelance Statistician, Heverlee, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Möhlhenrich SC, Kniha K, Peters F, Heitzer M, Szalma J, Prescher A, Danesh G, Hölzle F, Modabber A. Evaluation of bone contact area and intercondylar distance changes in orthognathic surgery - a comparison between BSSO and HSSO technique depending on mandibular displacement extent. Clin Oral Investig 2024; 28:182. [PMID: 38424318 PMCID: PMC10904418 DOI: 10.1007/s00784-024-05584-8] [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: 11/04/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The present study aims to assess the impact of bilateral and high oblique sagittal split osteotomy (BSSO/HSSO), as well as displacement distances and directions on the expected and achievable bone contact area (BCA) and changes in the intercondylar distance (ICD). The primary question addressed is whether mandibular splitting through BSSO results in a greater BCA and/or ICD when compared to splitting through HSSO. MATERIALS AND METHODS Totally 80 mandibular displacements were performed on 20 fresh cadavers, for each subject, four splints were produces to facilitate mandibular advancement as well as setbacks of 4 and 8 mm. Pre- and postoperative CBCT scans were performed to plan the surgical procedures and to analyze the expected and achieved BCA and ICD. RESULTS Regarding the maximum mandibular displacement, the expected BCA for HSSO/BSSO were 352.58 ± 96.55mm2 and 1164.00 ± 295.50mm2, respectively, after advancement and 349.11 ± 98.42mm2 and 1344.70 ± 287.23mm2, respectively, after setback. The achieved BCA for HSSO/BSSO were 229.37 ± 75.90mm2 and 391.38 ± 189.01mm2, respectively, after advancement and 278.03 ± 97.65mm2 and 413.52 ± 169.52 mm2, respectively after setback. The expected ICD for HSSO/BSSO were 4.51 ± 0.73 mm and 3.25 ± 1.17 mm after advancement and - 5.76 ± 1.07 mm and - 4.28 ± 1.58 mm after setback. The achieved ICD for HSSO/BSSO were 2.07 ± 2.9 mm and 1.7 ± 0.60 mm after advancement and - 2.57 ± 2.78 mm and - 1.28 ± 0.84 mm after setback. Significant differences between the BCA after HSSO and BSSO were at each displacement (p < 0.001), except for the achieved BCA after 8-mm setback and advancement (p ≥ 0.266). No significant differences were observed regarding ICD, except for the expected ICD after 8-mm setback and advancement (p ≤ 0.037). CONCLUSIONS Compared to the virtual planning, the predictability regarding BCA and ICD was limited. ICD showed smaller clinical changes, BCA decreased significantly in the BSSO group. CLINICAL RELEVANCE BCA and ICD might have been less important in choosing the suitable split technique. in orthognathic surgery.
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Affiliation(s)
- Stephan Christian Möhlhenrich
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany.
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Josef Szalma
- Department Oral and Maxillofacial Surgery, Medical School, University of Pécs, 1. Tüzér St., Pécs, 7623, Hungary
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, Medical Faculty of RWTH-Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gholamreza Danesh
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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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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Wang S, Ge W, Qi L, Cao N, Meng J, Zhang L. Mandible-First Sequencing Increase Surgical Accuracy for Patients With Skeletal Class II Malocclusion Concomitant With Unstable Condyle-Fossa Relation. J Craniofac Surg 2023:00001665-990000000-01255. [PMID: 38055333 DOI: 10.1097/scs.0000000000009890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to explore whether mandible-first sequencing increases the surgical accuracy in bimaxillary orthognathic surgery for patients with skeletal class II malocclusion concomitant with the unstable condyle-fossa relation. A retrospective evaluation of 19 patients who had undergone virtually planned double-splint orthognathic surgery with different operation sequences was performed: maxilla-first (n=9) or mandible-first (n=10) surgery. The centroid position, translational, and rotational differences in the maxilla were evaluated by comparing the virtual plans with actual results. The stability was assessed by comparing the actual results with the follow-up outcomes 6 months postoperatively. The accuracy of the maxilla centroid position was improved in mandible-first sequencing surgery: mandible-first 1.87±0.94 mm versus maxilla-first 2.70±0.75 mm (P<0.05). Moreover, no significant difference was detected in the translational and orientational discrepancies between the 2 groups. Neither sequencing procedure differed in the overall stability: maxilla-first (1.48±1.13 mm) versus mandible-first (1.57±0.90 mm). This study indicated that the mandible-first surgery leads to a more accurate maxilla position than the maxilla-first surgery for patients with skeletal class II malocclusion concomitant with the unstable condyle-fossa relation.
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Affiliation(s)
- Shoupeng Wang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
- Department of Stomatology, Central Hospital of Xuzhou City, Xuzhou, Jiangsu Province, China
| | - Weiwen Ge
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Lei Qi
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Ningning Cao
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
| | - Jian Meng
- Department of Stomatology, Central Hospital of Xuzhou City, Xuzhou, Jiangsu Province, China
| | - Lei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology, Shanghai
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Naik KY, Lee KC, Rekawek P, Zoida J, Torroni A. Remodeling of the Temporomandibular Joint After Mandibular Setback Surgery: A 3D Cephalometric Analysis. J Oral Maxillofac Surg 2023; 81:1353-1359. [PMID: 37640238 DOI: 10.1016/j.joms.2023.08.004] [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: 03/22/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Condylar adaptations following orthognathic surgery remain an area of interest. Prior studies do not use 3-dimensional imaging modalities and lack standardization in the choice of osteotomy and movement when assessing condylar changes. PURPOSE The purpose of this study was to use 3-dimensional cephalometry to measure the association between osteotomy type (sagittal split osteotomy [SSO] vs vertical ramus osteotomy [VRO]) and changes in condylar volume and position. STUDY DESIGN, SETTING, AND SAMPLE This is a retrospective cohort study from January 2021 through December 2022 of patients at Bellevue Hospital in New York City, New York who were treated with either SSO or VRO for the correction of Class III skeletal malocclusion. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor was the type of mandibular osteotomy, sagittal split osteotomy, and vertical ramus osteotomy. MAIN OUTCOME VARIABLES The primary outcomes were changes in condylar volume (change measured in mm3) and relative position (anterior-posterior change utilizing the Pullinger and Hollinder method). COVARIATES Covariates included patient age, sex, setback magnitude, temporomandibular joint symptoms, and fixation method for SSO patients. ANALYSES Univariate comparisons were performed between independent variables and study outcomes. Volume changes were compared within each predictor using paired t-tests. Position changes were compared within each predictor using χ2 tests. If there were multiple significant univariate predictors, multiple regression models were created to predict volume and position changes. A P < .05 value was considered statistically significant. RESULTS The final sample comprised 30 condyles derived from 30 subjects. Mean age was 22.7 years (SD = 5.7) and mean setback was 3.9 mm (SD = 0.9). Twenty two condyles (73.3%) were subject to SSO with fixation, while the remaining 8 (26.7%) condyles were subject to intraoral VRO without fixation. When compared to VRO, condyles manipulated with SSO had greater volume loss (-177.2 vs -60.9 mm3; P = .03) and positional change (68.2 vs 12.5%; P < .01). Self-reported measures of postoperative pain, internal derangement, and myofascial symptoms were not significantly associated with either volume or positional changes. CONCLUSIONS AND RELEVANCE The SSO resulted in greater postoperative condylar volume loss and positional changes. These volume and positional changes were not correlated with self-reported temporomandibular disorder symptoms.
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Affiliation(s)
- Keyur Y Naik
- Resident, Division of Oral and Maxillofacial Surgery, New York University Langone Medical Center and Bellevue Hospital Center, New York, NY.
| | - Kevin C Lee
- Resident, Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Peter Rekawek
- Resident, Division of Oral and Maxillofacial Surgery, New York University Langone Medical Center and Bellevue Hospital Center, New York, NY
| | - Joseph Zoida
- Resident, Division of Oral and Maxillofacial Surgery, New York University Langone Medical Center and Bellevue Hospital Center, New York, NY
| | - Andrea Torroni
- Clinical Professor, Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY
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Grillo R, Brozoski MA, Samieirad S, Al-Moraissi EA, Cavalcante RCL, Naclério-Homem MDG. Global network mapping research findings on orthognathic surgery and temporomandibular disorder. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101531. [PMID: 37290748 DOI: 10.1016/j.jormas.2023.101531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The objective of this work is to assess the relationship between orthognathic surgery and temporomandibular disorders literature through a bibliometric analysis. METHODS A bibliographic search in line with the STROBE guidelines and the concepts of the Leiden Manifesto was performed on the Web of Science using the terms orthognathic surgery AND temporomandibular. A citation analysis and establishment of the more cited articles were performed. A graphical representation of the keywords was created with VOSviewer. RESULTS A total of 810 articles were analyzed in this study. The research revealed a significant increase in publications on this topic, particularly in English language articles and a high H-index. The publications represented 55 nations, with the highest number of articles coming from the USA. The discussion of highly cited articles covered various aspects such as the relationship between orthognathic surgery and TMD, including condylar resorption or displacement, predisposing factors, dentoskeletal and occlusion patterns, anatomical factors, osteotomy techniques, condylar positioning techniques, and emerging technologies for improved TMJ stability. CONCLUSION The analysis reveals an increasing research interest in this field, with a significant number of publications in English and a high citation rate per article, indicating the impact of the research. Various factors associated with TMD in orthognathic surgery are explored, including condylar alterations, predisposing factors, occlusion patterns, and surgical techniques. The study underscores the importance of thorough assessment, treatment, and monitoring of TMD in orthognathic surgery patients, while acknowledging the need for further research and consensus in management strategies.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
| | - Sahand Samieirad
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
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Lekroengsin B, Tachiki C, Takaki T, Nishii Y. Relationship between Changes in Condylar Morphology and Masticatory Muscle Volume after Skeletal Class II Surgery. J Clin Med 2023; 12:4875. [PMID: 37510990 PMCID: PMC10381303 DOI: 10.3390/jcm12144875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
The treatment of dentofacial deformities generally includes orthognathic surgery in which mandibular condyle changes following surgery are a common cause of relapse. This study investigated the changes in the mandibular condyle and related muscles to identify the factors that affected the changes in the mandibular condyle after orthognathic surgery in skeletal class II patients. This research studied 60 joints in 30 patients with skeletal class II dentofacial deformities who received surgical orthodontic treatment, including bilateral sagittal split ramus osteotomy, and underwent computed tomography before and after orthodontic treatment. The mandibular condyle, masseter, and medial pterygoid muscles were reconstructed and measured in 3D. Condylar positional and morphology changes, masseter and medial pterygoid muscle volume, temporomandibular joint (TMJ) pain, and distal segment movement were analyzed. The study observed that both the masseter and medial pterygoid muscle volumes decreased with statistical significance. The changes in the horizontal direction were positively correlated with the amount of movement. The findings indicated that mandibular condyle changes were significantly affected by the movement of the distal segment, the medial pterygoid muscle volume, and the direction of the distal segment, which influenced the treatment's long-term stability after orthognathic surgery.
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Affiliation(s)
| | - Chie Tachiki
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Takashi Takaki
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Yasushi Nishii
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan
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Mashkina AA, Chkadua TZ, Ermolin VI, Isaichikova OV, Romanovsky MA. [Three-dimensional assessment of positional changes of the mandibular condyles following orthognathic surgery]. STOMATOLOGIIA 2023; 102:19-27. [PMID: 36800781 DOI: 10.17116/stomat202310201119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
THE AIM THE STUDY This study aims to assess the postoperative condylar displacement after orthognathic surgery using three-dimensional analysis of computed tomography. MATERIAL AND METHODS This retrospective study included 64 condyles from 32 patients with skeletal Class II (Group 1, n=16) and III (Group 2, n=16) deformities. All patients underwent a bimaxillary surgery. The three-dimensional CT images were evaluated to assess condylar displacement. RESULTS The condyle exhibited mainly superior and lateral torque immediately after surgery. Posterior displaced condyles were found in two cases in group 1 (Class II malocclusion). CONCLUSION The present study found the condyle displacement that can be mistaken as posterior displacement of condyle in analysis of sagittal sections of CT scans.
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Affiliation(s)
- A A Mashkina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V I Ermolin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - M A Romanovsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Al-Wesabi SN, Abotaleb B, Al-Shujaa EA, Mohamed AA, Alkebsi K, Telha W, Jian S, Fuqiang X. Three dimensional condylar positional and morphological changes following mandibular reconstruction based on CBCT analysis: a prospective study. Head Face Med 2023; 19:3. [PMID: 36747208 PMCID: PMC9903492 DOI: 10.1186/s13005-023-00347-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the condylar positional changes following mandibular reconstruction with preservation of the condylar head using Cone-Beam Computed Tomography (CBCT). Also, to assess joint space changes and the overall volumetric space compared to the preoperative status. METHODOLOGY This prospective study included 30 patients (60 joints) subjected to unilateral mandibular resection and reconstruction with preservation of the condylar head. The Helkimo index and preoperative (T1), two weeks postoperative (T2), and follow-up CBCTs (T3) after at least six months were gathered and processed to evaluate the condylar position and TMJ joint space using Anatomage Invivo 6. A student's t-test and repeated-measures ANOVA statistics were used. A P value of less than 0.05 was considered statistically significant. RESULTS Thirty patients (14 males, 16 females) with a mean age of 40.01 ± 12.7 years (a range of 18.1-62.9 years) were included. On the tumor side, there were significant variances in the vertical and mediolateral condylar positions between the three-time points (T1, T2, T3). Immediately after the operation, the condyles were significantly displaced in a downward direction at T2, which became larger after the last follow-up period (T3) (p = 0.007). The condylar positions at the anteroposterior direction were relatively stable without significant differences between the three times points (p = 0.915). On the non-tumor side, the condylar positions were relatively stable in the mediolateral and anteroposterior positions. In the tumor side, all of the TMJ spaces were significantly increased in size following the mandibular reconstructions (T2 and T3). However, on the non-tumor side, the anterior, posterior, and medial joint spaces were significantly changed postoperatively. CONCLUSION After mandibular reconstruction with condylar preservation, the condylar position and volumetric measurement immediately changed noticeably and continued to be a permanent change over time compared to relatively stable condyles on the non-tumor side. According to Helkimo index, patients become adapted to the postoperative changes without significant differences between the two sides.
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Affiliation(s)
- Saddam Noman Al-Wesabi
- Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province, China. .,State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, Department of Oral implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China. .,Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - Bassam Abotaleb
- grid.444909.4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Eissa Abdo Al-Shujaa
- grid.32566.340000 0000 8571 0482Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province China ,grid.444909.4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Abdo Ahmed Mohamed
- grid.412536.70000 0004 1791 7851Department of Oral & Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khaled Alkebsi
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan China
| | - Wael Telha
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases and National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan China
| | - Sun Jian
- grid.32566.340000 0000 8571 0482Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province China
| | - Xie Fuqiang
- Lanzhou University, Second Hospital, Oral and Maxillofacial Surgery Department, Lanzhou, Gansu Province, China.
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Kim HS, Han SS, Lee C. Unintentional temporomandibular joint disc reduction after orthognathic surgery: A case report with long-term imaging follow-up. Imaging Sci Dent 2022; 52:409-413. [PMID: 36605856 PMCID: PMC9807793 DOI: 10.5624/isd.20220048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 01/09/2023] Open
Abstract
This report presents a rare case where a displaced temporomandibular joint (TMJ) disc was reduced to its normal position after orthognathic surgery, and long-term magnetic resonance imaging (MRI) follow-up visualized these postoperative changes. A 22-year-old male patient presented for facial asymmetry. He also complained of pain in the right TMJ area, and MRI showed disc displacements in both TMJs. After orthognathic surgery for facial asymmetry correction, the TMJ was re-evaluated. The symptom had resolved and the disc was positioned within the normal range during mouth opening. However, 6 and a half years after surgery, he complained of recurrent pain in the right joint, and MRI revealed medial disc displacement in the right TMJ. In conclusion, the influence of orthognathic surgery on the disc position might continue for a long time until the TMJ adapts to the new position. Careful and long-term follow-up is suggested to assess the TMJ complex.
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Affiliation(s)
- Hak-Sun Kim
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
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Chen CM, Chen PJ, Hsu HJ. Changes in Preexisting Temporomandibular Joint Clicking after Orthognathic Surgery in Patients with Mandibular Prognathism. Bioengineering (Basel) 2022; 9:bioengineering9120725. [PMID: 36550931 PMCID: PMC9774496 DOI: 10.3390/bioengineering9120725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the changes in preexisting temporomandibular joint (TMJ) clicking and the new incidence of TMJ clicking after orthognathic surgery. A total of 60 patients (30 men and 30 women) with mandibular prognathism underwent intraoral vertical ramus osteotomy (IVRO) for a mandibular setback. The setback amount and TMJ clicking symptoms (preoperative and one year postoperative) were recorded. To assess the risk of new incidence of TMJ clicking in asymptomatic patients, the cutoff value for postoperative mandibular setback was set at 8 mm. The left and right mandibular setbacks were 11.1 and 10.9 mm in men, respectively, and 10.7 and 10.0 mm in women, respectively. Thus, no difference in setback amount on either side was observed between the sexes. The improvement rate in patients with preexisting TMJ clicking was 69.2% (18 of 26 sides); the postoperative improvement rates were 71.4% (setback amount > 8 mm) and 60% (setback amount ≤ 8 mm). IVRO may reduce the severity of preexisting TMJ clicking. A high setback amount (>8 mm) may not be associated with a considerable increase in the risk of postoperative TMJ clicking.
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Affiliation(s)
- Chun-Ming Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Pei-Jung Chen
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Han-Jen Hsu
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- School of Oral Hygiene, College of Dental Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101
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Wang M, Qian Y, Zhao H, Zhu M, Yu H, Shen SG. Mandibular stability and condylar changes following orthognathic surgery in mandibular hypoplasia patients associated with preoperative condylar resorption. Clin Oral Investig 2022; 26:7083-7093. [PMID: 36151404 DOI: 10.1007/s00784-022-04668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate postoperative mandibular stability and condylar changes in patients with mandibular hypoplasia and preoperative condylar resorption (CR) undergoing orthognathic surgery. MATERIALS AND METHODS Fifty-four patients were included in this retrospective study. Computed tomography (CT) scans were acquired preoperatively (T0), 2-7 days immediate postoperatively (T1), and at least 1 year postoperatively (T2). Three-dimensional (3D) cephalometric analysis and measurements of condylar angle, volume, and position (joint spaces) were performed. A 2-mm mandibular relapse was deemed clinically acceptable. We also analyzed the correlations between relapse and postoperative CR and susceptible factors using a multivariate logistic regression model. RESULTS The results showed one year after the surgery, the average mandibular relapse was 1.0 mm (p < 0.05), and the average reduction of condylar volume was 152.4 mm3 (12.7%). Condyle-fossa relationships were improved immediately after the surgery, with a tendency of returning to their original state in the follow-up (p < 0.05). Anteroposterior advancement at point B (B-CP advancement) at T1 and superior joint space (SJS) at T0 were significantly correlated with mandibular relapse, and postoperative CR was mainly associated with vertical increasement at point B (B-AP increasement) at T1. The optimal cut-off values were as follows: 1.6 mm for SJS, 4.2 mm for B-CP advancement, and 1.8 mm for B-AP increasement. Concomitant advancement Genioplasty showed no significant correlation with relapse and postoperative CR. CONCLUSIONS While patients with mandibular hypoplasia and preoperative CR were vulnerable to further condylar resorption after mandibular advancement, the treatment outcomes were generally clinically acceptable. Postoperative relapse was associated with a larger than 4.2 mm of mandibular advancement measured at B-CP and a larger than 1.6 mm of superior joint space measured at SJS, and postoperative CR was associated with a larger than 1.8 mm of mandibular vertical increasement measured at B-AP. CLINICAL RELEVANCE The findings of this study suggested that the mandibular advancement might be limited to 5 mm for patients with preoperative CR. A concomitant advancement genioplasty might also be considered to achieve a better facial profile in these patients.
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Affiliation(s)
- Minjiao Wang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Yifeng Qian
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Hanjiang Zhao
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Min Zhu
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China
| | - Hongbo Yu
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China.
| | - Steve Gf Shen
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China. .,Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.
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Shen P, Zhang D, Luo Y, Abdelrehem A, Yang C. Characteristics of patients with temporomandibular joint idiopathic condylar resorption. Cranio 2022:1-7. [PMID: 35880737 DOI: 10.1080/08869634.2022.2100973] [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: 10/16/2022]
Abstract
OBJECTIVE To investigate characteristics of temporomandibular joint (TMJ) idiopathic condylar resorption (ICR) and analyze the related factors. METHODS A total of 755 consecutive patients (150 with ICR and 605 with anterior disc displacement [ADD]) from July 2015 to December 2018 were recruited. A comprehensive questionnaire characterizing the multidimensional impact of the TMJ was designed. Clinical examination and radiological evaluation were also performed. The odds ratio for each variable in the ICR group versus the ADD group was computed using logistic regression analysis. RESULTS Multivariate logistic regression analysis showed significant correlations between mouth opening restriction, disease course, mandibular retrusion, mandibular retrusion progression, skeletal Class II profile, and overjet in ICR patients. CONCLUSION These results suggest that a longer ADD disease course might have a strong relationship with ICR.
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Affiliation(s)
- Pei Shen
- Department of Oral Surgery, Shanghai Ninth People's Hospital; Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Dahe Zhang
- Department of Oral Surgery, Shanghai Ninth People's Hospital; Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Yi Luo
- Department of Oral Surgery, Shanghai Ninth People's Hospital; Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Egypt
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital; Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
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Kazemian M, Ghadiri Moghaddam N, Anbiaee N, Kermani H, Samiee Rad S. The Clinical and Radiographic Changes of Temporomandibular Joint (TMJ) Following Mandibular Set Back Surgery by Bilateral Sagittal Split Osteotomy (BSSO). World J Plast Surg 2022; 11:110-116. [PMID: 36117893 PMCID: PMC9446119 DOI: 10.52547/wjps.11.2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Bilateral Sagittal Split Osteotomy (BSSO) is one of the treatment options for Class III maxillary deficiency which may affect the condylar position and the patient's occlusion. We aimed to evaluate the clinical and radiographic changes of temporomandibular joint (TMJ) following mandibular set back surgery by BSSO. Methods In this retrospective study, All Class III patients, aged between 18-30 years old who underwent bimaxillary orthognathic surgery in the Oral and Maxillofacial Surgery Ward of Ghaem Hospital, Mashhad, Iran from January 2018- January 2020 were enrolled. Radiographic changes of joint space, condylar position and clinical changes for maximal mouth opening and joint sound were examined before and 6 months after surgery. Data were analyzed by SPSS16 software and the significance level of the data was set at P-value < 0.05. Results Twenty-five patients were recruited. The axial angle of the left and right condyle and condylar inclination on both sides reduced but this reduction was not statistically significant. While the anterior joint space was reduced and posterior joint space was increased in both sides, the changes on the right side were only significant (P = 0.039). In clinical examinations maximum mouth opening, lateral and protrusive movements were also decreased but this reduction was not statistically significant. Conclusion The mandibular set back with BSSO surgery in class III skeletal patients had no significant effect on the position of the condyle in the glenoid fossa as well as clinical symptoms.
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Affiliation(s)
- Mozhgan Kazemian
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Ghadiri Moghaddam
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Anbiaee
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Kermani
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samiee Rad
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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22
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Evaluation of Rhythmic Masseter Muscle Activity during Sleep and Awake in Patients with Dentofacial Deformity. J Maxillofac Oral Surg 2022; 21:481-486. [DOI: 10.1007/s12663-020-01467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022] Open
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Takahara N, Tomomatsu N, Kimura A, Kosugi M, Kurasawa Y, Morita KI, Yoda T. Changes in the condylar volume and skeletal relapse following orthognathic surgery in patients with dentofacial deformity: A retrospective study. Cranio 2022:1-11. [PMID: 35506653 DOI: 10.1080/08869634.2022.2070333] [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: 10/18/2022]
Abstract
OBJECTIVE To evaluate the relationship between the changes in condylar volume and maxillofacial skeletal morphology according to sex as well as the relationship between condylar volume reduction and skeletal relapse in patients who underwent orthognathic surgery. METHODS Ninety-five patients were categorized into skeletal Class III, Class II, and facial asymmetry groups. Computed tomography scans taken preoperatively and at 1 year postoperatively were used for quantitative measurement. RESULTS Postoperative condylar volume was reduced in both the Class II group and the deviated side of the asymmetry group. Both female and Class II deformity were significant predictors of postoperative reduction in the condylar volume. There was a significant correlation between skeletal relapse and postoperative change in condylar volume in the Class II group. CONCLUSION Postoperative condylar resorption may be associated with preoperative maxillofacial skeletal morphology and sex and also with skeletal relapse in the Class II group.
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Affiliation(s)
- Namiaki Takahara
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyoshi Tomomatsu
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kimura
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Machiko Kosugi
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Kurasawa
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei-Ichi Morita
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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24
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Lee YC, Sohn HB, Park YW, Oh JH. Evaluation of postoperative changes in condylar positions after orthognathic surgery using balanced orthognathic surgery system. Maxillofac Plast Reconstr Surg 2022; 44:11. [PMID: 35298724 PMCID: PMC8931136 DOI: 10.1186/s40902-022-00341-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many studies on maintaining the condyle in a normal or anatomical position during orthognathic surgery have been conducted to stabilize surgical outcomes and prevent iatrogenic temporomandibular joint complications. The aim of this study is to evaluate the changes in condylar positions after orthognathic surgery using virtual surgical planning via the balanced orthognathic surgery (BOS) system. Methods Postoperative changes in condylar position were retrospectively evaluated in 22 condyles of 11 patients with skeletal class III malocclusion who underwent orthognathic surgery using virtual surgical planning via the BOS system. The center point coordinates of the condylar head before and after orthognathic surgery were analyzed using voxel-based registration. Results Changes in the condylar position mainly occurred downward in the y-axis (−1.09 ± 0.62 mm) (P < 0.05). The change in the x-axis (0.02 ± 0.68 mm) and z-axis (0.01 ± 0.48 mm) showed no significant difference between before and after orthognathic surgery. Conclusion These results indicate that the changes in the condylar positions after orthognathic surgery using virtual surgical planning via the BOS system mainly occurred downward in the y-axis, with slight changes in the x- and z-axes. The change in the condylar position after orthognathic surgery using the BOS system is clinically acceptable.
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Affiliation(s)
- Yong-Chan Lee
- Bestian Oral & Maxillofacial Surgery Clinic, 429, Dogok-ro, Gangnam-gu, Seoul, 06208, Republic of Korea
| | - Hong-Bum Sohn
- Department of Orthodontics, Eton Dental Clinics, 98, Bangsong-gil, Chuncheon, Gangwondo, 24364, Republic of Korea
| | - Young-Wook Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7, Jukheon-gil, Gangneung, Gangwondo, 28644, Republic of Korea
| | - Ji-Hyeon Oh
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, 7, Jukheon-gil, Gangneung, Gangwondo, 28644, Republic of Korea.
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25
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Mashkina AA, Chkadua TZ, Ermolin VI, Isaichikova OV, Romanovsky MA. [Condylar displacement following orthognathic surgery]. STOMATOLOGIIA 2022; 101:77-84. [PMID: 36268926 DOI: 10.17116/stomat202210105177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The overview of the current literature in the research of mandibular condyle displacement after orthognathic surgeries was done. The correct postoperative mandibular condyle position is considered as one of the determinants of the stability of treatment results.
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Affiliation(s)
- A A Mashkina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - T Z Chkadua
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V I Ermolin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - M A Romanovsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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26
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Toh AQJ, Leung YY. The effect of orthognathic surgery on temporomandibular disorder. J Craniomaxillofac Surg 2021; 50:218-224. [PMID: 34887170 DOI: 10.1016/j.jcms.2021.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/17/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022] Open
Abstract
This study aimed to evaluate the difference in prevalence of temporomandibular disorder (TMD) before and after orthognathic surgery (OGS), particularly in patients with mandibular asymmetry. A prospective cohort study of patients undergoing corrective orthognathic surgery was conducted. Pre-operative and post-operative (3 months, 6 months and 1 year) TMD assessment were performed according to the Diagnostic Criteria for TMD (DC/TMD) protocol. 64 patients were included in the study. Overall, there was a significant reduction of 26.5% in TMD prevalence from 60.9% pre-operatively to 34.4% 1-year post-operatively (p = 0.003). In all, 37.5% of patients had their TMD condition treated, 50% had no change in their symptoms while 12.5% experienced a worsening of their symptoms. No significant difference in terms of change in TMJ status was observed among the different ramus procedures, the type and magnitude of mandibular movement, skeletal class, and presence of mandibular asymmetry. In conclusion, it appears that corrective orthognathic surgery for dentofacial deformities might provide a secondary benefit of treating TMD. However, surgeons have to be aware that a small percentage of patients might experience a deterioration of their TMD condition, and that those who were previously asymptomatic may develop TMD symptoms after surgery.
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Affiliation(s)
- Aileen Qiu Jin Toh
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
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27
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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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28
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Herpel C, Rammelsberg P, Schwindling FS. Nonsurgical treatment of class III malocclusion with temporomandibular disorder comorbidity: A clinical report. J Prosthet Dent 2021:S0022-3913(21)00512-6. [PMID: 34711408 DOI: 10.1016/j.prosdent.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022]
Abstract
The treatment of a 57-year-old woman with combined skeletal and pseudo-class III malocclusion who was also suffering from chronic myofascial orofacial pain is described. The challenge was to treat the patient's malocclusion while simultaneously managing the temporomandibular disorder. After a successful 3-month occlusal device therapy, which substantially reduced the patient's discomfort, a nonsurgical therapy by using complete-mouth fixed restorations was planned. The treatment was first tested by using printed interim restorations before monolithic zirconia restorations were provided. Stable occlusion and a pain-free outcome were observed at the 3-month follow-up.
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Affiliation(s)
- Christopher Herpel
- Researcher, Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Peter Rammelsberg
- Professor of Dental Medicine, Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
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29
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Bahmanyar S, Namin AW, Weiss RO, Vincent AG, Read-Fuller AM, Reddy LV. Orthognathic Surgery of the Mandible. Facial Plast Surg 2021; 37:716-721. [PMID: 34587642 DOI: 10.1055/s-0041-1735309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.
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Affiliation(s)
- Sara Bahmanyar
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Arya W Namin
- Department of Otolaryngology, University of Missouri School of Medicine, University of Missouri, Columbia, Missouri
| | - Robert O Weiss
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Aurora G Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
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30
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Virtual Surgical Planning Combined With Intraoperative Navigation in Mandibular Bilateral Sagittal Split Osteotomy for Accurate Placement of Patient Specific Implants. J Craniofac Surg 2021; 32:2666-2670. [PMID: 34260465 DOI: 10.1097/scs.0000000000007937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The aim of the study is to evaluate clinical methods to obtain a significantly improved fitting of patient specific implants (PSI) in bilateral sagittal split osteotomies and to evaluate the use of electromagnetic navigation as a potential guide for condyle positioning. A prospective study using (1) a solid bite registration index during preoperative computed tomography, (2) critical planning with regard to the condylar rotation, (3) a piezoelectric saw throughout the mandibular osteotomy, and (4) intraoperative navigation to determine the position of the PSIs and the mandibular segments intraoperatively was performed. Ten patients were treated. Five underwent bilateral sagittal split osteotomies and 5 bimaxillary osteotomy. All of the PSIs fitted precisely onto the mandible and the screws into the predrilled screw holes. The predetermined occlusion was obtained. A precise fitting of the PSIs in the lower jaw seems to be possible to achieve with above-mentioned methods. The intraoperative navigation system gives a possibility to verify the surgical outcome during surgery but is not accurate enough to be used as a virtual drill guide alone.
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31
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Grillo R. Orthognathic Surgery: A Bibliometric Analysis of the Top 100 Cited Articles. J Oral Maxillofac Surg 2021; 79:2339-2349. [PMID: 34245705 DOI: 10.1016/j.joms.2021.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE An increasing number of articles on orthognathic surgery are published every year. This paper aims to provide a list of the top 100 cited articles on orthognathic surgery to help any professional level with interest in this topic and to map the trends of orthognathic surgery publications over time. METHODS A bibliographic search (retrospective study) following STROBE guidelines was performed on Google Scholar (GS) and Dimensions with the term "orthognathic surgery" in the title, abstract, and keywords. The number of citations, citations per year, authors, and publication year were evaluated. A ranking was created in GS citations order with the top 100 cited articles and variables discussed individually. A graphical illustration of keywords was created using VOSviewer. These steps are fundamental in creating this list and relating it to all published articles on the topic. RESULTS A helpful list of the top 100 articles was developed to help professionals in entirely different manners. Virtual planning and complications in orthognathic surgery were the most cited topics, with a 95% confidence interval (P < .05). Some curiosities are discussed, such as increasing interest in surgery first and the relation between airway/obstructive sleep apnea and orthognathic surgery. CONCLUSIONS Bibliometric and altmetric analysis for free using Google Scholar and Dimensions is laborious but possible. Bibliometrics is a powerful tool to become actualized at any health professional level, from students to academics; and could save considerable effort and time for parties interested in the topic. Appropriate keywords are a crucial step to wider article dissemination.
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Affiliation(s)
- Ricardo Grillo
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil.
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32
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Peleg O, Mahmoud R, Shuster A, Arbel S, Manor Y, Ianculovici C, Kleinman S. Orthognathic surgery complications: The 10-year experience of a single center. J Craniomaxillofac Surg 2021; 49:891-897. [PMID: 33994296 DOI: 10.1016/j.jcms.2021.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022] Open
Abstract
The retrospective cohort study aimed to assess the incidence and characteristics of these complications in patients who underwent orthognathic procedures. Data on the intraoperative and the postoperative complications were extracted from the patients' medical files. Procedures were further subdivided into single-jaw procedures and bimaxillary procedures. A total of 209 orthognathic procedures were carried out in 190 patients. 184 (88%) were performed to treat angle class III malocclusion, while 25 (12%) aimed to treat class II malocclusion. A total of 94 complication events were observed (44.9% of 209 procedures). 22 of them occurred in single-jaw procedures (28.2% of 78 single jaw operations), and 72 occurred in bimaxillary procedures (55% of 131 bimaxillary operations). When compared regarding the type of complication, complication rates were comparable between the study groups with the exception of late-stage malocclusion. A significant difference (p-value = 0.028) in malocclusion incidences between the bimaxillary and single-jaw groups were observed (9 events, 4.3% and zero events, 0%, respectively). The majority of the complications during and following orthognathic surgical procedures are temporary or minor and require little or no treatment at all.
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Affiliation(s)
- Oren Peleg
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Reema Mahmoud
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Shuster
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shimrit Arbel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yifat Manor
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Clariel Ianculovici
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shlomi Kleinman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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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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34
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Ueki K, Moroi A, Takayama A, Saito Y, Sato M, Baba N, Kimura Y, Fujimoto K, Koizumi M, Hotta A, Iguchi R, Yoshizawa K. Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:496-505. [PMID: 34274287 DOI: 10.1016/j.oooo.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to assess mandibular morphologic changes to the condyle, ramus, mandibular body, and inferior mandibular border defect after sagittal split ramus osteotomy in class II and III patients. STUDY DESIGN The relationships among the condyle, ramus, and mandibular body measured by computed tomography preoperatively and postoperatively were assessed and factors related to the reduction of the condylar square and mandibular inferior border defect were examined. RESULTS Patients included 72 female patients with jaw deformity (36 skeletal class II cases, 36 skeletal class III cases). Postoperative reduction of the condylar square was significantly correlated with preoperative condylar height in patients with class II (P = .0297) vs preoperative condylar height and preoperative mandibular height in patients with class III (P < .0001). A mandibular inferior border defect was found in 18 of 72 class II sides (25.0%) and was significantly related to the position of the osteotomy line and attachment side of the inferior border cortex (P < .0001). CONCLUSIONS This study's findings suggest that the postoperative reduction of the condyle could be associated with preoperative condylar height. However, the mandibular inferior border defect in class II advancement surgery could be independently associated with technical factors in sagittal split ramus osteotomy.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Yuki Saito
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Momoko Sato
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Nana Baba
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Yujiro Kimura
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Kana Fujimoto
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Mai Koizumi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Asami Hotta
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Ran Iguchi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, Chuo-shi, Yamanashi, Japan
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NiÑo-Sandoval TC, Almeida RDAC, Vasconcelos BCDE. Incidence of condylar resorption after bimaxillary, Lefort I, and mandibular surgery: an overview. Braz Oral Res 2021; 35:e27. [PMID: 33605357 DOI: 10.1590/1807-3107bor-2021.vol35.0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/10/2020] [Indexed: 01/08/2023] Open
Abstract
The aim of the present overview was to evaluate the outcomes of systematic reviews to determine the incidence of condylar resorption in patients submitted to orthognathic surgery and analyze whether the risk of developing this condition is related to a specific type of surgery. Searches were conducted in the PubMed/MEDLINE, Embase, and Cochrane electronic databases for systematic reviews with quantitative data on condylar resorption due to any type of orthognathic surgery for dentoskeletal deformities published up to May 25, 2019. The AMSTAR 2 and Glenny tools were applied for the quality appraisal. Five systematic reviews were included for analysis. Only one article was considered to have high quality. Among a total of 5128 patients, 12.32% developed condylar resorption. From those patients, 70.1% had double jaw surgery, 23.4% had mandibular surgery alone, and in 6.5% a Lefort I technique was used. Based on these findings, bimaxillary surgery could be considered a risk factor for condylar resorption. However, these results should be interpreted with caution, since other factors, such as pre-operative skeletal deformities, type of movement, and type of fixation, can contribute to the development of this condition. Further studies should consider reporting main cephalometric data, temporomandibular diagnosis, hormonal levels, and tomographic measures before and after the surgery at least every 6 months during the firsts two years to identify accurately risk factors for condylar resorption.
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Affiliation(s)
- Tania Camila NiÑo-Sandoval
- Universidade de Pernambuco - UPE, School of Dentistry , Department of Oral and Maxillofacial Surgery , Recife , PE , Brazil
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Ueki K, Yoshizawa K, Saito Y, Takayama A, Baba N, Kimura Y, Koizumi M, Fujimoto K, Iguchi R, Sato M, Osada AH, Moroi A. Evaluation of condylar surface CT values related to condylar height reduction after orthognathic surgery. J Craniomaxillofac Surg 2021; 49:639-648. [PMID: 33994298 DOI: 10.1016/j.jcms.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
This study was performed to evaluate the relationship between condylar height reduction and changes in condylar surface computed tomography (CT) values in jaw deformity patients following orthognathic surgery. Mandibular advancement by sagittal split ramus osteotomy (SSRO) with Le Fort I osteotomy was performed in class II patients, and mandibular setback by SSRO with Le Fort I osteotomy was performed in class III patients. The maximum CT values (pixel values) at five points on the condylar surface and the condylar height, ramus height, condylar square, ramus angle, and gonial angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement (ADD) or other types by using magnetic resonance imaging (MRI). Ninety-two condyles of 46 female patients were prepared for this study. Their temporomandibular joints (TMJs) were divided into two groups based on class (46 joints in class II and 46 joints in class III) and two groups based on the findings (25 joints with ADD and 67 joints with other findings). ADD with and without reduction was observed in two joints in the class III group and in 23 joints in the class II group. The distribution of ADD incidence had not changed 1 year after surgery. Condylar height decreased 1 year after surgery in both class II patients (mandibular advancement) (p < 0.0001) and class III patients (mandibular setback) (p = 0.0306). Similarly, condylar height decreased 1 year after surgery both in patients who showed ADD (p = 0.0087) and those with other types (p = 0.0023). Significant postoperative increases at all angle sites on the condylar surface were found in the class II (p < 0.05) and ADD (p < 0.05) groups. This study showed that an enhanced condylar surface CT value might be one sign of condylar height reduction related to sequential condylar resorption, in combination with ADD.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan.
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Yuki Saito
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Nana Baba
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Yujiro Kimura
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Mai Koizumi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Kana Fujimoto
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Ran Iguchi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Momoko Sato
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Asami Hotta Osada
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3893, Japan
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Bergamaschi IP, Cavalcante RC, Fanderuff M, Gerber JT, Petinati MFP, Sebastiani AM, da Costa DJ, Scariot R. Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects. Clin Oral Investig 2021; 25:3801-3808. [PMID: 33415380 DOI: 10.1007/s00784-020-03709-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms. MATERIALS AND METHODS Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level. RESULTS The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p < 0.05), the functional limitation domain increased (p = 0.014), and the physical disability domain did not show an association (p = 0.133). There were improvements in articular pain (p = 0.016), chronic pain (p = 0.019), and nonspecific physical symptoms excluding pain (p = 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p < 0.05). CONCLUSION Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively. CLINICAL RELEVANCE Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.
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Affiliation(s)
- Isabela Polesi Bergamaschi
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Rafael Correia Cavalcante
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Marina Fanderuff
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Jennifer Tsi Gerber
- School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil
| | - Maria Fernanda Pivetta Petinati
- School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil
| | - Aline Monise Sebastiani
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil. .,School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil.
| | - Delson João da Costa
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil
| | - Rafaela Scariot
- Department of Stomatology, School of Dentistry of Universidade Federal do Paraná, 632 Prefeito Lothário Meissner Avenue, Curitiba, Paraná, 80210-170, Brazil.,School of Health Sciences, Universidade Positivo, 5300 Prof. Pedro Viriato Parigot de Souza Street, Curitiba, Paraná, 81280-330, Brazil
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Lee LM, Zhang DD, Zhu YM, Cheng HN, Yao W, Liang X, Deng QY. Outcomes of treatment with genioplasty and temporomandibular joint anchorage surgery. J Craniomaxillofac Surg 2021; 49:177-183. [PMID: 33451942 DOI: 10.1016/j.jcms.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/09/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Anterior Disc Displacement without Reduction (ADDwoR) in adolescence can result in condylar resorption which produces mandibular retrusion/deviation (MR/D) in adulthood. This study aims to analyze the therapeutic effect of simultaneous genioplasty and temporomandibular joint (TMJ) anchorage surgery on ADDwoR with MR/D patients. METHODS During 2016-2018, ADDwoR with MR/D cases were included and underwent TMJ anchorage surgery and genioplasty guided by digital design. Pre-/Post-surgical clinical manifestations, facial photography, radiographic data, facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed. RESULTS A total of 32 cases (52 joints) were included. The average age was 24.09. Ratio of male/female was 4/28. Visual analog pain scale (VAS) score pre-/post-surgical ranged from 3 to 9 and 0-3, with an average of 6.03 and 1.18 (p < 0.01). Maximal mouth opening pre-/post-surgical ranged from 16 to 33 mm and 33-40 mm, with an average of 22.43 mm and 36.46 mm (p < 0.01). MRI was completed and showed stable disc reduction without recurrence 1 year postoperatively. MR/D was corrected and a better face shape was obtained. The satisfaction rate of clinicians, patients and third-parties was 92.375%, 94.156% and 94.218%, with an average of 93.583%. CONCLUSION For ADDwoR with MR/D patients, simultaneous TMJ anchorage surgery and genioplasty can improve TMJ symptoms/functions, correct facial appearance, and enhance the degree of satisfaction. The postoperative effect is stable, safe and reliable, which is worthy of clinical promotion.
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Affiliation(s)
- Lee Mui Lee
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Dan Di Zhang
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Yao Min Zhu
- Department of Oral&Maxillofacial Surgery, Shenzhen Stomatology Hospital Affiliated to Shenzhen University,Shenzhen University, 70# GuiYuan North Road, LuoHu District, Shenzhen City, GuangDong Province, China.
| | - Hui Na Cheng
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Wei Yao
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
| | - Xiao Liang
- Department of Anesthesiology, Shenzhen Stomatology Hospital Affiliated to Shenzhen University, Shenzhen University, China.
| | - Qiang Yong Deng
- Department of Stomatology,Shenzhen University General Hospital and Shenzhen University Clinical Medical Academy,Shenzhen University, 1098# XueYuan Road, NanShan District, Shenzhen City, 518055, GuangDong Province, China.
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Comparison of condylar displacement after sagittal split ramus osteotomy depending on the glenoid fossa depth. J Craniomaxillofac Surg 2021; 49:9-16. [DOI: 10.1016/j.jcms.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022] Open
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40
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Castro VA, Pereira RMA, Mascarenhas GM, Neto AIT, Perez DE, Rodrigues D, Prado CJ, Zanetta-Barbosa D. Magnetic resonance imaging evaluation of articular disk position after orthognathic surgery with or without concomitant disk repositioning: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:276-285. [PMID: 33229287 DOI: 10.1016/j.oooo.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes of 2 surgical treatment options: one for correction of class II malocclusion skeletal deformity and one for pre-existing temporomandibular joint (TMJ) disorders requiring orthognathic surgery (OS) for correction of dentofacial deformity. STUDY DESIGN This retrospective study evaluated patients who underwent OS with maxillomandibular advancement (MMA) with or without concomitant TMJ surgery for articular disk repositioning (ADR). Patients were divided into 2 groups: group I (MMA) was treated with OS only (18 patients); and group II (MMA-ADR) was treated with OS and concomitant ADR (19 patients). The sample consisted of 74 TMJs (mean patient age 29.86 years). RESULTS In group I, 38.5% of the disks that were originally in normal position became displaced after OS, and 33.3% of displaced disks with reduction became nonreducing after OS. In group II, 78.9% of disks exhibited normal position in the final evaluation, and 97.3% of patients showed improved disk position after surgery. There was significant symptom improvement in all patients in group II, but no significant improvement in group I. CONCLUSIONS OS with ADR appears to produce stable and beneficial results in improving symptoms in patients with displaced disk and TMJ pain.
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Affiliation(s)
- Vanessa A Castro
- Postgraduate PhD student, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil; Private Practitioner, Salvador, BA, Brazil
| | - Rafael M A Pereira
- Assistant Professor, School of Dentistry, University Center of Patos de Minas, Patos de Minas, Minas Gerais, Brazil.
| | - Gustavo M Mascarenhas
- Private Practitioner, Salvador, BA, Brazil; Postgraduate PhD student, School of Dentistry, São Leopoldo Mandic, Campinas, SP, Brazil
| | | | - Daniel E Perez
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas, San Antonio, TX, USA
| | - Daniel Rodrigues
- Private Practitioner, Salvador, BA, Brazil; Assistant Professor, Residency of Oral and Maxillofacial Surgery, Federal University of Bahia, Salvador, BA, Brazil
| | - Célio J Prado
- Adjunct Professor, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Darceny Zanetta-Barbosa
- Adjunct Professor, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
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Ploder O, Sigron G, Adekunle A, Burger-Krebes L, Haller B, Kolk A. The Effect of Orthognathic Surgery on Temporomandibular Joint Function and Symptoms: What are the Risk Factors? A Longitudinal Analysis of 375 Patients. J Oral Maxillofac Surg 2020; 79:763-773. [PMID: 33285107 DOI: 10.1016/j.joms.2020.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The effects of orthognathic surgery (OGS) on the temporomandibular joint (TMJ) are still controversial. Based on a high-volume uniform collective, the function and clinical symptoms of the TMJ and the dysfunction index (Di) by Helkimo were evaluated prior and up to 2 years after OGS. METHODS A longitudinal cohort study was performed between 2006 and 2016. A comprehensive examination focusing on TMJ function, temporomandibular disorder (TMD) symptoms, and the Di had been performed preopertaively (T0) and postoperatively at 6 weeks (T1), 6 months (T2), 1 year (T3), and 2 years (T4). The predictor variables used were sex, age, skeletal class, type of surgery, and amount of dysfunction or number of TMD complaints before treatment. The outcome of this study was TMD symptoms and the Di. Descriptive and bivariate statistics were computed, and the significance level was set at P < .05. RESULTS The sample consisted of 375 patients (247 women, 128 men, mean age 28.1 ± 9.4 years), 269 with skeletal Class II (71.7%) and 106 with skeletal Class III (28.3%) treated with sagittal split osteotomy bilateral sagittal split osteotomy (n = 173) or Le Fort I and bilateral sagittal split osteotomy (n = 202). Severe signs of dysfunction (Di 2/3) were seen in 5.9% of the patients before OGS and in 2.1% of the patients 2 years after OGS. The difference in Di (Di0/1 and Di2/3) between T0 and T1/T2 was statistically significant (P = .028; P = .011, respectively). TMD symptoms were significantly reduced 2 years after OGS (P = .028). Female gender (P = .013), skeletal Class II (P < .001), and counterclockwise rotation (P < .001) were the only risk factors significantly associated with the occurrence of TMD at T1. CONCLUSIONS The results of this study suggest that in most cases TMD symptoms can be significantly reduced and only a few can be induced with OGS. No risk factors were found for long-term effects on the TMJ.
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Affiliation(s)
- Oliver Ploder
- Head, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Guido Sigron
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Adeola Adekunle
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Laura Burger-Krebes
- Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria; and Postdoc student, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Kolk
- Head, Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria.
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Zhai Y, Han JJ, Jung S, Kook MS, Park HJ, Oh HK. Changes in the temporomandibular joint clicking and pain disorders after orthognathic surgery: Comparison of orthodontics-first approach and surgery-first approach. PLoS One 2020; 15:e0238494. [PMID: 32886686 PMCID: PMC7473545 DOI: 10.1371/journal.pone.0238494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.
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Affiliation(s)
- Ying Zhai
- Graduate Dental School, Chonnam National University, Gwangju, Republic of Korea
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
- Hard-tissue Biointerface Research Center, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea
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The quantitative correlation between condylar resorption and skeletal relapse following mandibular advancement in skeletal class II malocclusion patients. J Craniomaxillofac Surg 2020; 48:839-844. [DOI: 10.1016/j.jcms.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/12/2020] [Accepted: 07/05/2020] [Indexed: 11/22/2022] Open
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Mirow E, Sifakakis I, Keilig L, Bourauel C, Patcas R, Eliades T, Dörsam I. Quantitative appraisal of bilateral sagittal split osteotomy impact on the loading of temporomandibular joint. J Mech Behav Biomed Mater 2020; 111:103985. [PMID: 32861207 DOI: 10.1016/j.jmbbm.2020.103985] [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: 04/08/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Abstract
Bilateral sagittal split osteotomy is one of the most frequently performed operations in orthognathic surgery. The health of the temporomandibular joint (TMJ) is an important prerequisite for its functionality. The aim of this finite element study was to assess the developed stresses during mouth opening after bilateral sagittal split osteotomy. Different osteotomy gap widths and disc positions were evaluated. Computed tomography and magnetic resonance data of a dentulous cadaver head were used in order to create two finite element models simulating split distances of 5 and 10 mm, respectively. The fixation of the distal and proximal segments was made by a four- or a six-hole titanium mini plate and four monocortical screws respectively. For both models, three different situations of the articular disc were created: a physiological disc position, anterior disc displacement and posterior disc displacement. The mandible was vertically displaced in the midline in order to simulate a mouth opening of 20 mm. The simulation showed high stresses in the area of the titanium plates (up to 850 MPa), implying an increased risk of material failure. High stresses were found within the discs in the models with normal disc position and anterior disc displacement as well (up to 8 MPa), indicating a higher risk of developing craniomandibular disorders. Regarding the stresses within the fixation screws, the highest values were recorded in the area of the upper thread. The degree of mandibular advancement after a bilateral sagittal split osteotomy affects the stress balance in the mandible and the articular discs during mouth opening.
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Affiliation(s)
- Eva Mirow
- Oral Technology, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Iosif Sifakakis
- Department of Orthodontics, School of Dentistry, University of Athens, 2 Thivon Str, 115 27, Goudi, Athens, Greece
| | - Ludger Keilig
- Oral Technology, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany; Department of Prosthetic Dentistry, Preclinical Education and Materials Science, Dental School, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Christoph Bourauel
- Oral Technology, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland
| | - Istabrak Dörsam
- Oral Technology, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany; Department of Prosthetic Dentistry, Preclinical Education and Materials Science, Dental School, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.
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Changes in the temporomandibular joint position depending on the sagittal osteotomy technique and extent of mandibular movement. Int J Oral Maxillofac Surg 2020; 50:356-366. [PMID: 32620453 DOI: 10.1016/j.ijom.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/14/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022]
Abstract
The bilateral sagittal split osteotomy (BSSO) and high oblique sagittal split osteotomy (HSSO) are common techniques for mandibular movement in orthognathic surgery. The aim of this study was to evaluate the influence of both techniques, as well as movement distances and directions, on the position of the temporomandibular joint (TMJ). A total of 80 mandibular movements were performed on 20 fresh human cadaver heads, four on each head. Pre- and postoperative cone beam computed tomography was used to plan the surgical procedure and analyse the TMJ. Reference measurements included the anterior, superior, and posterior joint spaces, intercondylar distances and angles in the axial and coronal planes, and the sagittal, coronal, and axial angulations of the proximal segment. Only minor differences were found between the BSSO and HSSO techniques, particularly in terms of the intercondylar angle in the axial plane (P < 0.03) and the condylar angle of the proximal segment in the sagittal plane (P < 0.011). Observed changes in the TMJ were mostly opposite when moving the mandible forwards and backwards and increased with increasing movement distance. BSSO and HSSO result in similar changes in TMJ position. The extent of the movement distance influences the position of the condyle more than the osteotomy technique.
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Ok SM, Kim JH, Kim JS, Jeong EG, Park YM, Jeon HM, Heo JY, Ahn YW, Yu SN, Park HR, Kim KH, Ahn SC, Jeong SH. Local Injection of Growth Hormone for Temporomandibular Joint Osteoarthritis. Yonsei Med J 2020; 61:331-340. [PMID: 32233176 PMCID: PMC7105408 DOI: 10.3349/ymj.2020.61.4.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Osteoarthritis (OA) of the temporomandibular joint (TMJ) elicits cartilage and subchondral bone defects. Growth hormone (GH) promotes chondrocyte growth. The aim of this study was to evaluate the efficacy of intra-articular injections of GH to treat TMJ-OA. MATERIALS AND METHODS Monosodium iodoacetate (MIA) was used to induce OA in the TMJs of rats. After confirming the induction of OA, recombinant human GH was injected into the articular cavities of rats. Concentrations of GH and IGF-1 were measured in the blood and synovial fluid, and OA grades of cartilage and subchondral bone degradation were recorded by histological examination and micro-computed tomography. RESULTS MIA-induced OA in the rat TMJ upregulated insulin-like growth factor-1 (IGF-1) rather than GH levels. GH and IGF-1 concentrations were increased after local injection of GH, compared with controls. Locally injected GH lowered osteoarthritic scores in the cartilage and subchondral bone of the TMJ. CONCLUSION Intra-articular injection of GH improved OA scores in rat TMJs in both cartilage and subchondral bone of the condyles without affecting condylar bone growth. These results suggest that intra-articular injection of human GH could be a suitable treatment option for TMJ-OA patients in the future.
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Affiliation(s)
- Soo Min Ok
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Jin Hwa Kim
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Ji Su Kim
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Eun Gyo Jeong
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Yang Mi Park
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Hye Mi Jeon
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Jun Young Heo
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Yong Woo Ahn
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea
| | - Sun Nyoung Yu
- Department of Microbiology & Immunology, Pusan National University School of Medicine, Yangsan, Korea
| | - Hae Ryoun Park
- Department of Oral Pathology, Pusan National University School of Dentistry, Yangsan, Korea
| | - Kyung Hee Kim
- Deptartment of Oral Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Soon Cheol Ahn
- Department of Microbiology & Immunology, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Hee Jeong
- Department of Oral Medicine, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
- Department of Oral Medicine, Dental and Life Science Institute, Pusan National University School of Dentistry, Yangsan, Korea.
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Baranto H, Weiner CK, Burt IA, Rosén A. Satisfactory outcomes after orthognathic surgery with surgically assisted rapid maxillary expansion using a hybrid device. J Oral Sci 2020; 62:107-111. [PMID: 31996512 DOI: 10.2334/josnusd.19-0078] [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: 11/01/2022]
Abstract
The self-reported functional outcomes, clinical findings, and results of dental cast analysis before and after orthognathic surgery with surgically assisted rapid maxillary expansion (SARME) using a hybrid rapid maxillary expander (RME) were evaluated. Data were collected from 43 patients who underwent orthognathic surgery with SARME using a hybrid RME between 2001 and 2013. The patients were recruited during a follow-up clinical examination and were required to complete a questionnaire about their opinions and self-reported functional outcomes. Dental casts were used to analyze posttreatment palatal expansion. The mean follow-up time was 68 months (range: 25-135 months). The most common indication for SARME was the presence of a crossbite. Of the 30 patients who underwent a follow-up clinical examination (69.8% answer rate), 4 (13.3%) had symptoms of temporomandibular disorder (TMD), 1 (3.3%) experienced myalgia, and 3 (10.0%) experienced arthralgia on clinical palpation. Cast analysis revealed significant palatal expansion. The intercanine distance, intermolar distance, and palatal height were increased by 3, 5, and 2 mm, respectively. Overall, the patients were satisfied with the preoperative information, improved functions, and aesthetic results. The prevalence of TMD symptoms and other side effects following orthognathic surgery with SARME using a hybrid RME was low, and significant palatal expansions were achieved.
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Affiliation(s)
- Helen Baranto
- Department of Oral and Maxillofacial Surgery, Folktandvården Eastman Institutet
| | - Carina K Weiner
- Department of Oral and Maxillofacial Surgery, Folktandvården Eastman Institutet
| | - Idil A Burt
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institute
| | - Annika Rosén
- Department of Clinical Dentistry, Section of Oral & Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Bergen
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Kita S, Fujita K, Imai H, Aoyagi M, Shimazaki K, Yonemitsu I, Omura S, Ono T. Postoperative stability of conventional bimaxillary surgery compared with maxillary impaction surgery with mandibular autorotation for patients with skeletal class II retrognathia. Br J Oral Maxillofac Surg 2020; 58:57-61. [DOI: 10.1016/j.bjoms.2019.10.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
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49
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Wolford LM. Comprehensive Post Orthognathic Surgery Orthodontics: Complications, Misconceptions, and Management. Oral Maxillofac Surg Clin North Am 2019; 32:135-151. [PMID: 31685347 DOI: 10.1016/j.coms.2019.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Post orthognathic surgery patient management is critical for high-quality and predictable outcomes. Surgeons and orthodontists must have the knowledge and ability to implement postsurgical management protocols and strategies to provide the best care and outcomes possible. This article presents basic concepts, philosophies, treatment protocols, risks, and potential complications associated with postsurgical patient management. Postsurgical orthodontic goals are to maximize the occlusal fit and provide predictable means to retain the occlusion. Aggressive orthodontic mechanics may be required to provide the best occlusal fit. Complications can occur, but early recognition of complications and implementation of corrective tactics should minimize adverse outcomes.
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Affiliation(s)
- Larry M Wolford
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Baylor University Medical Center - Private Practice, 3409 Worth Street, Suite #400, Dallas, TX 75246, USA; Department of Orthodontics, Texas A&M University College of Dentistry, Baylor University Medical Center - Private Practice, 3409 Worth Street, Suite #400, Dallas, TX 75246, USA.
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50
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Kretschmer WB, Baciuţ G, Baciuţ M, Sader R. Effect of bimaxillary orthognathic surgery on dysfunction of the temporomandibular joint: a retrospective study of 500 consecutive cases. Br J Oral Maxillofac Surg 2019; 57:734-739. [PMID: 31255372 DOI: 10.1016/j.bjoms.2019.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
Abstract
We investigated the effect of bimaxillary orthognathic surgery on symptoms in the temporomandibular joint (TMJ) and predictive factors for postoperative dysfunction. A total of 500 patients with different craniofacial deformities who were having bimaxillary orthognathic surgery were assessed for overjet, overbite, maximal mouth opening, maximal protrusion, maximal lateral movement to both sides, and symptoms of TMJ dysfunction (pain on palpation, clicking, or crepitus) before operation and one year postoperatively. The panoramic radiographs taken on the same dates were assessed for reduction in the height of the ramus. Other variables were age, sex, segmentation of the maxilla, and additional genioplasty. Changes in the symptoms of dysfunction were investigated with the McNemar test. Measurements of the maximum mandibular movements taken preoperatively and postoperatively were compared using the paired t test. Multivariate logistic regression was used to assess the influence of the variables on symptoms preoperatively and postoperatively. The effect of occlusal stability (overjet and overbite) on postoperative symptoms in the TMJ was investigated with the unpaired t test. Women and class II patients had significantly more pain on palpation preoperatively, and a significant reduction in pain on palpation and clicking after operation. Predictive factors were preoperative crepitus for postoperative pain, and preoperative clicking for postoperative clicking. Patients with and without symptoms showed no significant differences in overjet and overbite postoperatively. Condylar resorption was found in 29 patients (5.8 %), and only 14 of them had symptoms in the TMJ. In patients with no preoperative symptoms or radiological abnormalities of the condyle, condylar resorption was rare (0.8 %). Orthognathic surgery has a beneficial effect on dysfunction of the TMJ as it reduces pain and clicking considerably. Patients should be informed, however, that TMJ disorders could still develop even if they had no symptoms preoperatively.
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Affiliation(s)
- W B Kretschmer
- Department of Head-, Neck- and Facial Plastic Surgery, Medius Klinik Ostfildern-Ruit, Germany.
| | - G Baciuţ
- Department of Cranio-Maxillofacial Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - M Baciuţ
- Department of Cranio-Maxillofacial Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - R Sader
- Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
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