Surgical-prosthetic correction of dentofacial deformities

3D analysis of condylar position after sagittal split osteotomy of the mandible in mono- and bimaxillary orthognathic surgery - a methodology study in 18 patients

OBJECTIVES

This study analyzes the condylar position with intercondylar distance and angle after sagittal split osteotomy in mono- and bimaxillary orthognathic surgery applying cone-beam computed tomography (CBCT) images before and after surgery.

MATERIALS AND METHODS

Data of 18 patients, ten males (mean age 28 years) and eight females (mean age 26 years) undergoing the described surgery between 2008 and 2009 were analyzed. CBCT scans were performed with the KaVo 3DeXam (KaVo, Biberach/ Riß, Germany) (identical with the iCAT scan device) before and after surgery. The exported DICOM data were analyzed with ImageJ morphometry software. Patients were also asked about TMJ problems. The two-tailed t test was used and significance was set at a p value less than p = 0.05.

RESULTS

There was no significant difference between the pre- and postoperative distances between condylar centers (mean difference: 1 mm) (p = 0.69) and intercondylar angle (mean difference: 6.6°) (p = 0.27).

CONCLUSIONS

CBCT is a novel imaging technique appropriate for detailed and three-dimensional analysis of the condylar position in orthognathic surgery. Available freeware analysis software can be applied for metrical measurements. Our cases showed no significant changes of condylar position immediately after surgery without intraoperative condylar fixation.

Mandibular body sagittal osteotomy in the correction of malunited edentulous mandibular fractures

The severely atrophied mandible presents multiple problems in reduction and fixation when bilateral mandibular body fractures occur. These problems sometimes result in malunited fractures. The two most common malpositions in these situations include a clockwise rotation (viewed from the patient's right) of the distal fragment and/or the counter-clockwise rotation of a proximal fragment. Body sagittal osteotomy as originally described by Sáda (1966) offers some advantages in the secondary reconstruction of these mandibular deformities. Five patients with mandibular body malunions have been treated successfully with two cases used in this article to demonstrate the application of body sagittal osteotomy. Permanent damage to the inferior alveolar nerve appears minimal and no other significant problems were encountered.