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Ravelo V, Parra M, Muñoz G, J Otero J, Olate S. Mandibular Contouring in Subjects With Class II or Class III Dentofacial Deformities and Treatment Needs. J Craniofac Surg 2024:00001665-990000000-01737. [PMID: 38949262 DOI: 10.1097/scs.0000000000010441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Facial contouring relates to hard and soft structures that make up the face. Skeletal class II and III subjects present bone structure and position changes, significantly impacting the soft tissues. This study aims to analyze the morphology of the mandible at mandibular ramus and angle level in subjects with skeletal facial deformity class II and III who are candidates for orthognathic surgery and to define implications in facial contour. A cross-sectional study used cone beam computed tomography to compare the mandibular contour (mandibular angle and ramus region) in orthognathic surgery candidates. One hundred sixty orthognathic surgery candidates were analyzed, ranging in age from 18 to 58 years (31.29 ± 11.97). Regarding the skeletal class, 95 (59.37%) were skeletal class II, and 65 (40.62%) were skeletal class III. Class II subjects had a larger antegonial notch than class III subjects. Concerning the mandibular contour, class II subjects presented less vertical distance than class III subjects, but both presented similar gonial angles. Concerning the ideas to assess the need for mandibular contouring surgery, the 2 proposals to determine the need for mandibular contouring surgery in class II and III subjects present a similar distribution. The mandibular notch is an objective element and is commonly present in subjects with a class II facial pattern; this element can be used in contour analysis to define expected facial characteristics, including the patient's facial sex, in the decision of surgical techniques for lower facial contour augmentation or reduction.
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Affiliation(s)
- Victor Ravelo
- Undergraduate Research Group in Dentistry (GIPO), Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco
| | - Marcelo Parra
- Division of Oral, Facial y Maxillofacial Surgery, Faculty of Dentistry, Universidad de La Frontera
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera
| | - Gonzalo Muñoz
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera
- Department of Pediatric Dentistry y Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Chile
| | - J J Otero
- Facial Contouring Unit, Hospital Recoletas Burgos, Associate Professor, Dental School, Department of Surgery, San Pablo CEU, Madrid, España
| | - Sergio Olate
- Division of Oral, Facial y Maxillofacial Surgery, Faculty of Dentistry, Universidad de La Frontera
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera
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Ravelo V, Olate G, de Moraes M, Huentequeo C, Sacco R, Olate S. Condylar Positional Changes in Skeletal Class II and Class III Malocclusions after Bimaxillary Orthognathic Surgery. J Pers Med 2023; 13:1544. [PMID: 38003858 PMCID: PMC10672009 DOI: 10.3390/jpm13111544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023] Open
Abstract
Orthognathic surgery is indicated to modify the position of the maxillomandibular structure; changes in the mandibular position after osteotomy can be related to changes in the position of the mandibular condyle in the articular fossa. The aim of this study was to determine changes produced in the mandibular condyle 6 months after orthognathic surgery. A cross-sectional study was conducted that included subjects who had undergone bimaxillary orthognathic surgery to treat dentofacial deformity of Angle class II (group CII) or Angle class III (group CIII). Standardized images were taken using cone-beam computed tomography 21 days before surgery and 6 months after surgery; measurement scales were used to identify the condylar position and its relations with the anterior, superior, and posterior joint spaces. The results were analyzed using the Shapiro-Wilk and Student's t-tests, while considering a value of p < 0.05 as indicating a significant difference. Fifty-two joints from 26 patients, with an average age of 27.9 years (±10.81), were analyzed. All subjects in both group CII and group CIII showed a significant change in the anterior, superior, and posterior joint spaces. However, postoperative changes in the position of the condyle in the articular fossa were not significant in the anteroposterior analysis. We conclude that orthognathic surgery causes changes in the sagittal position of the mandibular condyle in subjects with mandibular retrognathism and prognathism.
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Affiliation(s)
- Víctor Ravelo
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
- PhD Program in Morphological Sciences, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile
| | - Gabriela Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
| | - Marcio de Moraes
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Piracicaba 13414-903, SP, Brazil
| | - Claudio Huentequeo
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
| | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RW, UK
| | - Sergio Olate
- Division of Oral and Maxillofacial Surgery & CEMYQ, Universidad de La Frontera, Temuco 4780000, Chile
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Olate S, Ravelo V, Alister JP, Netto HD, Haidar ZS, Sacco R. Early Treatment of Unilateral Condylar Hyperplasia in Adolescents: Preliminary Results. J Clin Med 2023; 12:jcm12103408. [PMID: 37240513 DOI: 10.3390/jcm12103408] [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: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 05/28/2023] Open
Abstract
Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a rare disease. The aim of this study was to evaluate the clinical conditions of progressive facial asymmetry in young subjects treated with high condylectomy. A retrospective study was performed including nine subjects diagnosed with UCH type 1B and progressive facial asymmetry around 12 years old with an upper canine progressing towards dental occlusion. After an analysis and a decision of treatment, orthodontics began one to two weeks prior to the condylectomy (with a mean vertical reduction of 4.83 ± 0.44 mm). Facial and dental asymmetry, dental occlusion, TMJ status and an open/closing mouth were analyzed before surgery and in the final stage of treatment, almost 3 years after surgery. Statistical analyses were performed using the Shapiro-Wilk test and a Student's t-test considering a p value of <0.05. Comparing T1 (before surgery) and T2 (once orthodontic treatment was finalized), the operated condyle showed a similar height to that observed in stage 1 with a 0.12 mm difference in height (p = 0.8), whereas the non-operated condyle showed greater height increase with an average of 3.88 mm of vertical growth (p = 0.0001). This indicated that the non-operated condyle remained steady and that the operative condyle did not register significant growth. In terms of facial asymmetry in the preoperative stage, a chin deviation of 7.55 mm (±2.57 mm) was observed; in the final stage, there was a significant reduction in the chin deviation with an average of 1.55 mm (±1.26 mm) (p = 0.0001). Given the small number of patients in the sample, we can conclude that high condylectomy (approx. 5 mm), if performed early, especially in the mixed-dentition stage before full canine eruption, is beneficial for the early resolution of asymmetry and thus the avoidance of future orthognathic surgery. However, further follow-up until the end of facial growth is required.
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Affiliation(s)
- Sergio Olate
- Division of Oral, Facial and Maxillofacial Surgery, Dental School, Universidad de La Frontera, Temuco 4780000, Chile
- Center of Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4780000, Chile
| | - Victor Ravelo
- Grupo de Investigación de Pregrado en Odontología (GIPO), Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - Juan Pablo Alister
- Division of Oral, Facial and Maxillofacial Surgery, Dental School, Universidad de La Frontera, Temuco 4780000, Chile
- Center of Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4780000, Chile
| | - Henrique Duque Netto
- Department of Oral and Maxillofacial Surgery, Federal University of Juiz de Fora, Juiz de Fora 36000-000, Brazil
| | - Ziyad S Haidar
- Centro de Investigación e Innovación Biomédica (CiiB), Universidad de los Andes, Santiago 7550000, Chile
- BioMAT'X R&D&I (HAiDAR I+D+i) LAB, Facultad de Odontología, Universidad de los Andes, Santiago 7550000, Chile
| | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RS, UK
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Olate S, Ravelo V, Huentequeo C, Parra M, Unibazo A. An Overview of Clinical Conditions and a Systematic Review of Personalized TMJ Replacement. J Pers Med 2023; 13:533. [PMID: 36983715 PMCID: PMC10053320 DOI: 10.3390/jpm13030533] [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: 02/10/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023] Open
Abstract
The temporomandibular joint (TMJ) is a complex structure in the cranio-maxillomandibular region. The pathological changes of the joint cause deficiencies at different levels, making its replacement necessary in some cases. The aim of this article is to analyze the current indications, treatment and criteria, and follow-up using a systematic review and case series. A systematic review was carried out, identifying the indications for the use of a customized TMJ prosthesis and evaluating criteria and validation in the international literature. After review and exclusion, 8 articles were included with a minimum follow-up of 12 months. The age of the subjects was between 18 and 47 years old. In 226 patients, 310 TMJ prostheses were installed, 168 bilaterally and 142 unilaterally. In most of the articles, a good condition in the follow-up was observed, with a reduction in pain and better conditions of mandibular movement and function. TMJ prosthesis and replacement is a protocolized, defined, stable, and predictable procedure. Indications and criteria must be evaluated by specialists and patients related to the pathology involved in TMJ deformity or degeneration. Randomized research with an accurate diagnosis and follow-up is necessary to obtain the best indication for this treatment.
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Affiliation(s)
- Sergio Olate
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
- Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4811230, Chile
| | - Víctor Ravelo
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
| | - Claudio Huentequeo
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
| | - Marcelo Parra
- Center for Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4811230, Chile
- Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco 4811230, Chile
| | - Alejandro Unibazo
- Division of Oral and Maxillofacial Surgery, Hospital A.G.P., Lautaro 4811230, Chile
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Prakash O, Verma SK, Jha AK, Mallick S, Ekram S, Soni M. Surgery-First Approach for Dentofacial Deformity: A Systematic Review. Cureus 2023; 15:e35085. [PMID: 36938263 PMCID: PMC10023129 DOI: 10.7759/cureus.35085] [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: 11/10/2022] [Accepted: 02/08/2023] [Indexed: 02/19/2023] Open
Abstract
This review is based on the surgery-first approach for dentofacial deformity. This review has critically highlighted various promising aspects and factors associated with dentofacial deformity and can be viewed as valuable research work. In addition, this review highlights a systematic manner of surgery that can reduce the possible duration of treatment. The main findings of the review have established that the appropriate approaches to surgery can be beneficial for patients of any age group. The surgery-first approach is mainly utilized for tissue transfer as well as oral cancer as the first-line treatment. This critical review has successfully evaluated the limitations and advantageous traits of the specific surgery approach that has been outlined in this context. It has established the surgery approach as an effective measurement to reduce the time taken for treatment without compromising the patient's health. In the final phase of this review, the accuracy and appropriateness of this surgery-first approach have been effectively demonstrated.
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Affiliation(s)
- Om Prakash
- Department of Oral and Maxillofacial Surgery, Dental College, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Santosh K Verma
- Department of Periodontology, Dental College, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Awanindra K Jha
- Department of Orthodontic and Dentofacial Orthopedic, Dental College, Rajendra institute of medical sciences, Ranchi, IND
| | - Saurabh Mallick
- Department of Oral and Maxillofacial Surgery, Mallick Dental and Maxillofacial Center, Ranchi, IND
| | - Subia Ekram
- Department of Oral and Maxillofacial Surgery, Dental College, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Mukesh Soni
- Department of Oral and Maxillofacial Surgery, Northern Railway Central Hospital, New Delhi, IND
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Roman R, Almășan O, Hedeșiu M, Băciuț M, Bran S, Popa D, Ban A, Dinu C. Evaluation of the Mandibular Condyle Morphologic Relation before and after Orthognathic Surgery in Class II and III Malocclusion Patients Using Cone Beam Computed Tomography. BIOLOGY 2022; 11:biology11091353. [PMID: 36138832 PMCID: PMC9495726 DOI: 10.3390/biology11091353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
Simple Summary In individuals with severe malocclusions, orthognathic surgery seeks to rebalance the relationships between the jaws by providing a stable occlusion, a healthy muscle balance, and the functioning of the temporomandibular joint. Cone beam computed tomography may be used to determine the position of the mandibular condyle in the glenoid fossa. This study aimed to assess how the position of the mandibular condyle varies in class II and III malocclusions before and after bimaxillary orthognathic surgery. Before and after orthognathic surgery, 56 TMJs from 28 patients were studied. Following surgery, both class II and class III patients experienced changes in the anterior joint space, posterior joint space, condyle position, and condyle angle. The preliminary findings are promising for determining changes in condyle position and joint spaces that might guide oral and maxillofacial surgeons to address a debilitating clinical affliction. Abstract This study aimed at evaluating the mandibular condyle position changes before and after bimaxillary orthognathic surgery in class II and III malocclusion patients. CBCT scans from patients who underwent bimaxillary orthognathic surgery were analyzed: Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). Both condyles were independently assessed for their largest anterior and posterior joint spaces, smallest medial joint spaces, and condyle angles concerning the transverse line. In the sagittal plane, the minimum size of the anterior and posterior joint spaces was measured. In the coronal plane, the smallest medial joint space was measured. The position of the condyle within the glenoid fossa was determined before and after surgery. A total of 56 TMJs from 28 patients were studied. Following orthognathic surgery, the anterior and posterior space in class II increased. Postoperatively, the anterior joint space in class III decreased. In 42.85% of malocclusion class II patients and 57.14% of malocclusion class III patients, the pre-and post-surgical position of the condyle changed, the condyle was anteriorly positioned (42.85%) in class II patients and centrically positioned (71.4%) in class III patients. Significant changes in the joint space, condylar position, and condyle angle were found in the class II and class III subjects.
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Affiliation(s)
- Raluca Roman
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hațieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
- Correspondence:
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Daiana Popa
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Alina Ban
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Iuliu Hațieganu University of Medicine and Pharmacy, 37 Iuliu Hossu Street, 400029 Cluj-Napoca, Romania
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