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Yun CW, Kim KH, Lee W, Kim SH. Comparative Analysis of Temperature-Responsive Hydrogel (PF 72) for Postoperative Pain After Bimaxillary Surgery: A Retro-spective Study. Aesthetic Plast Surg 2024; 48:1271-1275. [PMID: 38326500 DOI: 10.1007/s00266-023-03846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Abstract
Bimaxillary surgery is a painful invasive procedure in plastic surgery. Pain control is typically achieved using intravenous analgesics. We aimed to investigate the efficacy of a novel temperature-responsive hydrogel, PF72, mixed with ropivacaine, as a local pain management solution when applied directly to the surgical site following orthognathic surgery. The study was conducted from October 2022 to July 2023 and included a cohort of 40 candidates for orthognathic surgery, encompassing LeFort I maxillary ostectomy and sagittal split ramus osteotomy. The participants were divided into an Injection group (n = 20), where PF72 was administered at the surgical site before the orthognathic surgery, and a Control group (n = 20), which relied solely on intravenous analgesics. Pain was evaluated at 3, 6, 24, 48, and 72 h after surgery using a numerical rating scale (NRS). The mean NRS scores at 24 h were 6.35 and 4 for the Control and Injection groups, respectively. The mean NRS scores at 72 h were 3.4 and 2.55 for the Control and Injection groups, respectively. Patients who received PF72 experienced less pain than those who received intravenous analgesics. These findings underscore the potential of PF72 as an effective alternative for enhancing pain management in patients undergoing orthognathic surgery.Level of Evidence III Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chang Woon Yun
- Department of Plastic and Reconstructive Surgery, View Plastic Surgery, Seoul, Republic of Korea
| | - Ki Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Republic of Korea
| | - Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei E1 Plastic Surgery Clinic, Anyang, Republic of Korea
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Republic of Korea.
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Habib AA, Sharara AA, Yousry TN, Swidan AO. Accuracy of computer-assisted design and manufactured three-dimensional device for condylar positioning in mandibular bilateral sagittal split osteotomy (clinical trial). Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:331-337. [PMID: 38155012 DOI: 10.1016/j.oooo.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Aligning dental arches in orthognathic treatment after undergoing LeFort I osteotomy or bilateral sagittal split osteotomy (BSSO) relies on occlusal splints, which do not provide precise control over the condylar head. AIM OF THE STUDY To clinically and radiographically assess the accuracy of computer-assisted design and manufactured (CAD/CAM) surgical guide for condylar positioning in a BSSO. MATERIALS AND METHODS The study recruited 8 patients with a non-syndromic dentofacial deformity who underwent a BSSO. Surgery was planned according to CAD/CAM technology. After osteotomy, a pre-operative guide was used, followed by a repositioning guide. Computed tomography scans were conducted on all patients 1 week pre-operatively, immediately, and 3 months postoperatively. RESULTS The data are presented as median values with the 25th and 75th percentiles. Eight patients (37.50% females and 62.50% males) between the ages of 19 and 24 underwent BSSOs. The surgical procedure successfully corrected their skeletal deformities. The absolute change between immediate postoperative and pre-operative condylar angle was 0.15 (0.00-0.3). The absolute change between 3 months postoperative and pre-operative condylar angle was 0.20 (0.00-0.30). CONCLUSION The stability of the condylar head in position is well assessed by 3-dimensional condylar positioning devices designed and manufactured by CAD/CAM technology in the mandibular BSSO.
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Affiliation(s)
- Aliaa A Habib
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Ahmed A Sharara
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Tarek N Yousry
- Orthodontics Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed O Swidan
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Narahara S, Morita Y, Shido R, Yoshida N, Ohba S. Comparison of the skeletal stability after mandibular counter-clockwise rotation in three surgical procedures. Odontology 2024; 112:640-646. [PMID: 37880466 DOI: 10.1007/s10266-023-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023]
Abstract
The treatment of mandibular deformities with an anterior open bite is challenging. In this study, skeletal stability after mandibular osteotomies was evaluated to determine the best treatment for mandibular prognathism with an anterior open bite in three procedures: intraoral vertical ramus osteotomy (IVRO), conventional sagittal split ramus osteotomy (conv-SSRO), and SSRO without bone fixation (nonfix-SSRO). Patients who underwent mandibular osteotomy to correct skeletal mandibular protrusion were included. Changes in skeletal and soft tissues were assessed using lateral cephalograms taken before (T1), 3 ± 2 days (T2), and 12 ± 3 months (T3) after surgery. Thirty-nine patients were included: nine in the IVRO group and 11 and 19 in the conv- and nonfix-SSRO groups, respectively. The mandibular plane angles (MPAs) of the T2-T1 were - 2.7 ± 2.0 (p = 0.0040), - 3.7 ± 1.7 (p < 0.0001), and - 2.3 ± 0.7 (p < 0.0001) in the IVRO, conv-SSRO, and nonfix-SSRO groups, respectively. The skeletal relapse of the MPAs was not related to the MPA at T2-T1, and it was approximately 1.3° in the conv-SSRO group. The skeletal relapse of the MAPs was significantly correlated with the MPA of T2-T1 in the IVRO (p = 0.0402) and non-fix-SSRO (p = 0.0173) groups. When the relapse of the MPAs was less than 1.3°, the MPA of T2-T1 was calculated as 2.5° in the nonfix-SSRO group. When the MPA of T2-T1 is less than 2.5°, non-fix SSRO may produce a reliable outcome, and when it is more than 2.5°, conv-SSRO may produce better outcomes.
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Affiliation(s)
- Shun Narahara
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Yukiko Morita
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Rena Shido
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Noriaki Yoshida
- Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
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Malkoc Y, Gulsever S, Uckan S. Change in taste sensation after orthognathic surgery. Clin Oral Investig 2024; 28:237. [PMID: 38558265 PMCID: PMC10984883 DOI: 10.1007/s00784-024-05626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation. MATERIALS AND METHODS Thirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups. RESULTS There were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05). CONCLUSION Taste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions. CLINICAL RELEVANCE Maxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly. THE TRIAL REGISTRATION NUMBER (TRN) NCT06103422/Date of registration: 10.17.2023 (retrospectively registered).
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Affiliation(s)
- Yagmur Malkoc
- Graduate School of Health Sciences, School of Dentistry, İstanbul Medipol University, Atatürk Bulvarı No:27, 34083 Unkapanı, Fatih, İstanbul, Türkiye.
| | - Serap Gulsever
- Department of Oral and Maxillofacial Surgery, School of Dentistry, İstanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı, 34214, Bağcılar, İstanbul, Türkiye
| | - Sina Uckan
- Department of Oral and Maxillofacial Surgery, School of Dentistry, İstanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı, 34214, Bağcılar, İstanbul, Türkiye
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Holte MB, Pinholt EM. Validation of a fully automatic three-dimensional assessment of orthognathic surgery. J Craniomaxillofac Surg 2024; 52:438-446. [PMID: 38369395 DOI: 10.1016/j.jcms.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
The aim of the present study was to propose and validate FAST3D: a fully automatic three-dimensional (3D) assessment of the surgical accuracy and the long-term skeletal stability of orthognathic surgery. To validate FAST3D, the agreement between FAST3D and a validated state-of-the-art semi-automatic method was calculated by intra-class correlation coefficients (ICC) at a 95 % confidence interval. A one-sided hypothesis test was performed to evaluate whether the absolute discrepancy between the measurements produced by the two methods was statistically significantly below a clinically relevant error margin of 0.5 mm. Ten subjects (six male, four female; mean age 24.4 years), class II and III, who underwent a combined three-piece Le Fort I osteotomy, bilateral sagittal split osteotomy and genioplasty, were included in the validation study. The agreement between the two methods was excellent for all measurements, ICC range (0.85-1.00), and fair for the rotational stability of the chin, ICC = 0.54. The absolute discrepancy for all measurements was statistically significantly lower than the clinical relevant error margin (p < 0.008). Within the limitations of the present validation study, FAST3D demonstrated to be reliable and may be adopted whenever appropriate in order to reduce the work load of the medical staff.
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Affiliation(s)
- Michael Boelstoft Holte
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Else Marie Pinholt
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
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Ueki K, Moroi A, Takayama A, Yoshizawa K. Assessment of temporomandibular joint disc position and skeletal stability after bimaxillary surgery. Oral Maxillofac Surg 2024; 28:137-148. [PMID: 37280442 DOI: 10.1007/s10006-023-01161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery. METHODS The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed. RESULTS The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements. CONCLUSION This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements.
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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-Shi, Yamanashi, 409-3893, Japan.
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan
| | - Akihiro Takayama
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan
| | - Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan
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Valls-Ontañón A, Kesmez Ö, Starch-Jensen T, Triginer-Roig S, Neagu-Vladut D, Hernández-Alfaro F. Bilateral sagittal split osteotomy with or without concomitant removal of third molars: a retrospective cohort study of related complications and bone healing. Oral Maxillofac Surg 2024; 28:345-353. [PMID: 36959345 DOI: 10.1007/s10006-023-01148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To carry out a comparative evaluation of the intra- and postoperative complications, and bone healing, following bilateral sagittal split osteotomy (BSSO) with or without concomitant removal of third molars. MATERIAL AND METHODS A retrospective analysis was performed of two cohorts subjected to BSSO with the intraoperative removal of third molars (test group) versus the removal of third molars at least 6 months prior to BSSO (control group), comprising at least 1 year of clinical and radiographic follow-up. Partially or completely erupted third molars were extracted immediately before completing the osteotomy, whereas impacted third molars were removed after the osteotomy had been performed. Hardware reinforcement was performed in bimaxillary cases where concomitant molar extraction impeded placement of the retromolar bicortical screw of the hybrid technique. RESULTS A total of 80 surgical sites were included (40 in each group). Concomitant extraction of the molar represented a mean increase in surgery time of 3.7 min (p < 0.001). No additional complications occurred in the test group (p = 0.476). The gain in bone density was preserved in both groups (p = 0.002), and the increase was of the same magnitude in both (p = 0.342), despite the fact that the immediate and final postoperative bone densities were significantly higher in the control group (p = 0.020). CONCLUSION The results obtained support concomitant molar extraction with BSSO as a feasible option.
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Affiliation(s)
- Adaia Valls-Ontañón
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain.
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.
| | - Özlem Kesmez
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - David Neagu-Vladut
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain
| | - Federico Hernández-Alfaro
- Institute of Maxillofacial Surgery, Teknon Medical Center, Carrer de Vilana, 12 (Desp. 185), 08022, Barcelona, Spain
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jeong BJ, Ohe JY, Ryu JI, Choi BJ, Jung J. The effect of tongue reduction for preventing adverse effects in patients undergoing class III orthognathic surgery: a three-dimensional comparative analysis. Clin Oral Investig 2024; 28:162. [PMID: 38383912 DOI: 10.1007/s00784-024-05554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES This study aims to evaluate the potential benefits of combining tongue reduction with mandibular setback surgery in patients undergoing class III orthognathic surgery. Specifically, we investigated whether this combined approach reduced the risk of surgical relapse, condylar resorption, and airway space reduction by mitigating tongue pressure on the mandible. MATERIAL AND METHODS The study retrospectively enrolled patients who had undergone bilateral sagittal split ramus osteotomy (BSSRO) with at least 5 mm of setback and met the criteria of a body mass index > 20 kg/m2 and tongue volume > 100 mm3. The study included 20 patients with 10 in the tongue reduction group (TR, n = 10) and 10 in the BSSRO only group (SO, n = 10). RESULTS The volumetric changes of the total airway space were significantly different between the TR and SO groups (p = 0.028). However, no significant differences were observed in the condylar resorption and postoperative relapse between the groups (p = 0.927 and 0.913, respectively). The difference between the resorption of the anterior and posterior segments of the condyle was also statistically insignificant (p = 0.826). Postoperative counterclockwise rotation of the proximal segment only demonstrated a significant correlation with postoperative relapse (p = 0.048). CONCLUSIONS The reduction in tongue volume demonstrated a preventive effect on the reduction of the airway space after mandibular setback, although it did not yield statistical significance concerning surgical relapse and condylar volume. The counterclockwise rotation of the proximal segment might be responsible for the forward displacement of the distal segment and postoperative relapse. However, the clinical implications of this finding should be interpreted with caution owing to the limited sample size CLINICAL RELEVANCE: Tongue reduction could potentially serve as a preventive measure in preserving the airway space and might be beneficial in mitigating the risk of obstructive sleep apnea in patients with class III deformity.
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Affiliation(s)
- Bong-Jin Jeong
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Joo-Young Ohe
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Byung-Joon Choi
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - Junho Jung
- Department of Oral & Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447, Seoul, Republic of Korea.
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Huang D, Zou L, Lu C, Zhao J, He D, Yang C. Simultaneous standard total joint prosthesis reconstruction with SSRO and Le Fort I osteotomy in the treatment of unilateral temporomandibular joint ankylosis with jaw deformity: a case cohort study. Clin Oral Investig 2024; 28:163. [PMID: 38383876 PMCID: PMC10881754 DOI: 10.1007/s00784-024-05543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures. METHODS Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups. RESULTS Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups. CONCLUSION Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD.
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Affiliation(s)
- Dong Huang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Luxiang Zou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Dongmei He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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蔡 安, 王 晓, 周 文, 柳 忠. [Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:74-80. [PMID: 38318899 PMCID: PMC10845172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To compare the difference between virtual surgical planning (VSP) position and postoperative real position of maxilla and condyle, and to explore the degree of intraoperative realization of VSP after orthognathic surgery. METHODS In this study, 36 patients with mandibular protrusion deformity from January 2022 to December 2022 were included. All the patients had been done bilateral sagittal split ramus osteotomy (SSRO) combined with Le Fort Ⅰ osteotomy under guidance of VSP. The VSP data (T0) and 1-week postoperative CT (T1) were collected, the 3D model of postoperative CT was established and segmented into upper and lower jaws in CCMF Plan software. At the same time, accor-ding to the morphology of palatal folds, the virtual design was registered with the postoperative model, and the unclear maxillary dentition in the postoperative model was replaced. Then the postoperative model was matched with VSP model by registration of upper skull anatomy that was not affected by the operation. The three-dimensional reference plane and coordinate system were established. Selecting anatomical landmarks and their connections of condyle and maxilla for the measurement, we compared the coordinate changes of marker points in three directions, and the angle changes between the line connecting the marker points and the reference plane to analyze the positional deviation and the angle deviation of the postoperative condyle and maxilla compared to VSP. RESULTS The postoperative real position of the maxilla deviates from the VSP by nearly 1 mm in the horizontal and vertical directions, and the anteroposterior deviation was about 1.5 mm. In addition, most patients had a certain degree of counterclockwise rotation of the maxilla after surgery. Most of the bilateral condyle moved forward, outward and downward (the average distance deviation was 0.15 mm, 1.54 mm, 2.19 mm, respectively), and rotated forward, outward and upward (the average degree deviation was 4.32°, 1.02°, 0.86°, respectively) compared with the VSP. CONCLUSION VSP can be mostly achieved by assistance of 3D printed occlusal plates, but there are certain deviations in the postoperative real position of maxilla and condyle compared with VSP, which may be related to the rotation axis of the mandible in the VSP. It is necessary to use patient personalized condylar rotation axis for VSP, and apply condylar positioning device to further improve surgical accuracy.
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Affiliation(s)
- 安东 蔡
- 北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
- 滨州医学院口腔医学院,数字化口腔医学山东省高校特色实验室,山东烟台 264003Characteristic Laboratories of Colleges and Universities in Shandong Province for Digital Stomatology, School of Stomatology, Binzhou Medical University, Yantai 264003, Shandong, China
| | - 晓霞 王
- 北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 文娟 周
- 滨州医学院附属烟台口腔医院,数字化口腔医学技术烟台市工程研究中心,山东烟台 264000Yantai Engineering Research Center for Digital Technology of Stomatology, The affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264000, Shandong, China
| | - 忠豪 柳
- 滨州医学院口腔医学院,数字化口腔医学山东省高校特色实验室,山东烟台 264003Characteristic Laboratories of Colleges and Universities in Shandong Province for Digital Stomatology, School of Stomatology, Binzhou Medical University, Yantai 264003, Shandong, China
- 滨州医学院附属烟台口腔医院,数字化口腔医学技术烟台市工程研究中心,山东烟台 264000Yantai Engineering Research Center for Digital Technology of Stomatology, The affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264000, Shandong, China
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徐 心, 吴 灵, 宋 凤, 李 自, 张 益, 刘 筱. [Mandibular condyle localization in orthognathic surgery based on mandibular movement trajectory and its preliminary accuracy verification]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:57-65. [PMID: 38318897 PMCID: PMC10845196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To establish and assess the precision of pre-surgical condyle position planning using mandibular movement trajectory data for orthognathic surgery. METHODS Skull data from large-field cone beam computed tomography (CBCT) and dental oral scan data were imported into IVSPlan 1.0.25 software for 3D reconstruction and fusion, creating 3D models of the maxilla and mandible. Trajectory data of mandibular movement were collected using a mandibular motion recorder, and the data were integrated with the jaw models within the software. Subsequently, three-dimensional trajectories of the condyle were obtained through matrix transformations, rendering them visually accessible. A senior oral and maxillofacial surgeon with experience in both diagnosis and treatment of temporomandibular joint disease and orthognathic surgery selected the appropriate condyle position using the condyle movement trajectory interface. During surgical design, the mobile mandibular proximal segment was positioned accordingly. Routine orthognathic surgical planning was completed by determining the location of the mandibular distal segment, which was based on occlusal relationships with maxilla and facial aesthetics. A virtual mandible model was created by integrating data from the proximal and distal segment bone. Subsequently, a solid model was generated through rapid prototyping. The titanium plate was pre-shaped on the mandibular model, and the screw hole positions were determined to design a condylar positioning guide device. In accordance with the surgical plan, orthognathic surgery was performed, involving mandibular bilateral sagittal split ramus osteotomy (SSRO). The distal segment of the mandible was correctly aligned intermaxillary, while the proximal bone segment was positioned using the condylar positioning guide device and the pre-shaped titanium plate. The accuracy of this procedure was assessed in a study involving 10 patients with skeletal class Ⅱ malocclusion. Preoperative condyle location planning and intraoperative positioning were executed using the aforementioned techniques. CBCT data were collected both before the surgery and 2 weeks after the procedure, and the root mean square (RMS) distance between the preope-rative design position and the actual postoperative condyle position was analyzed. RESULTS The RMS of the condyle surface distance measured was (1.59±0.36) mm (95%CI: 1.35-1.70 mm). This value was found to be significantly less than 2 mm threshold recommended by the expert consensus (P < 0.05). CONCLUSION The mandibular trajectory may play a guiding role in determining the position of the mandibular proximal segment including the condyle in the orthognathic surgery. Through the use of a condylar positioning guide device and pre-shaped titanium plates, the condyle positioning can be personalized and customized with clinically acceptable accuracy.
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Affiliation(s)
- 心雨 徐
- />北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 灵 吴
- />北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 凤岐 宋
- />北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 自力 李
- />北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 益 张
- />北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - 筱菁 刘
- />北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Tekin G, Kose NS, Ugurlu M, Dereci O, Kosar YC, Gojayeva G, Caliskan G. Determining the safety margin of mandibular lingula in sagittal split ramus osteotomy. Surg Radiol Anat 2024; 46:159-166. [PMID: 38244088 DOI: 10.1007/s00276-023-03291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/20/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE The anatomical position of the lingula is clinically very important to prevent injuries during sagittal split ramus osteotomy. Our study aims to evaluate the localisation of the lingula by cone beam computed tomography (CBCT) and to compare the localisation of the lingula between malocclusion, gender, and lingula types. METHODS A retrospective study was conducted to evaluate the shape and location of the lingula using CBCT. A total of 250 CBCT images were included in this study. The lingula was classified as nodular, assimilated, truncated, or triangular type. Six defined distances from the top of the lingula were measured: anterior border of the ramus (L-A), posterior border of the ramus (L-P), internal oblique ridge (L-IOR), mandibular notch (L-N), and distal surface of the mandibular second molar (L-M2) and occlusal plane (L-OP). The measured distances were compared between gender, malocclusion, and lingula types. RESULTS The most common type of lingula was nodular (32.4%). The L-N, L-P, L-M2, and L-OP distances between genders were statistically higher in male patients than in female patients. The L-IOR, L-M2, and L-OP distances exhibited statistically significant differences found between malocclusions. No statistically significant difference was found when the distances of the lingula to the anatomical points were compared between the lingula types. CONCLUSION These variations in positioning of the lingula depending on the dysmorphoses are developing towards a systematic 3D examination before any mandibular osteotomy to precisely visualize the position and shape of the lingula.
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Affiliation(s)
- Gorkem Tekin
- Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey.
| | - Nesrin Saruhan Kose
- Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey
| | - Mehmet Ugurlu
- Department of Orthodontics, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey
| | - Omur Dereci
- Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey
| | - Yasin Caglar Kosar
- Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey
| | - Gunay Gojayeva
- Specialist in Oral and Maxillofacial Surgeon, Private Practice, Eskişehir, Turkey
| | - Gizem Caliskan
- Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, Turkey
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Thongngam T, Srimaneekarn N, Sirintawat N, Kasemsarn W. Relationship of the Degree of Nerve Exposure and Surgical Manipulation and Short-Term Neurosensory Disturbance Following Sagittal Split Ramus Osteotomy: A Prospective Study. J Oral Maxillofac Surg 2024; 82:159-168. [PMID: 37989495 DOI: 10.1016/j.joms.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Neurosensory disturbance (NSD) is a common complication after sagittal split ramus osteotomy (SSRO) due to inferior alveolar nerve (IAN) injury. The impact of intraoperative nerve manipulation on NSD remains debated. PURPOSE The purpose of this study was to evaluate the influence of IAN exposure and manipulation during SSRO on functional sensory recovery (FSR). STUDY DESIGN This was a single-center, prospective cohort study of 40 patients undergoing SSRO at Mahidol University from December 2020 to December 2021. The inclusion criteria were patients aged 20-34, ASA Class I-II. The exclusion criteria were patients with systemic bone disease, history of head and neck or neurological pathology, previous SSRO, or incomplete data collection. PREDICTOR VARIABLE Degree of intraoperative nerve manipulation was divided by the attending surgeon as follows; 1) Nerve fully encased in distal segment and not visible (NS); 2) Nerve encased in distal segment but partially visible (DS); and 3) Nerve partially encased in proximal segment and fully dissected free (PS). OUTCOME VARIABLES The area of interest was divided into the lip and chin. The primary outcome was time to FSR. The secondary outcome was subjective patient report, using a visual analogue scale, compared to FSR. COVARIATES The covariates were sex, age, skeletal diagnosis, degree of movement, and concomitant genioplasty/subapical procedure. ANALYSES Kaplan-Meier survival analysis, Cox proportional hazards regression, and Mcnemar test were utilized. P-value < .05 was significant. RESULTS In the lip, the median times to FSR were NS, 2 days; DS, 45 days; PS, 102 days. (Interquartile range: 77,127, 114, respectively) In the chin, the median times to FSR were NS, 23 days; DS, 92 days; PS, 87 days. (Interquartile range: 77, 161, 101, respectively.) Nerve manipulation significantly affected FSR in the lip and chin (P = .001, <0.001, respectively. Cox hazard ratios for DS and PS were lower compared to NS. Patients consistently reported more NSD compared to FSR as per Mcnemar test. CONCLUSION AND RELEVANCE After SSRO, FSR in the lip is prolonged when the IAN is partially encased in the proximal segment and released. This raises the question of the efficacy of surgically releasing a partially encased IAN.
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Affiliation(s)
- Tanutchaporn Thongngam
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natchalee Srimaneekarn
- Associate Professor, Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nattapong Sirintawat
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Warutta Kasemsarn
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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Buch FO, Stokbro K. Accuracy and stability of the condyle position after orthognathic surgery: A retrospective study. J Craniomaxillofac Surg 2024; 52:240-245. [PMID: 38172014 DOI: 10.1016/j.jcms.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/21/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
The purpose of this study was to evaluate the accuracy and stability of condylar positioning in patients treated with bimaxillary procedures compared with patients treated with maxillary procedures alone. All patients had undergone treatment at Odense University Hospital and were treated with inferior maxillary procedures. The primary outcome was changes in condyle position and the primary predictor variable was time: pre-operative (T0) measurements to 1-week post-operative (T1) and 1-year post-operative (T2) measurements. Condyle movement was measured using dual voxel-based alignment. Sixteen patients were included. Seven patients underwent solitary maxillary procedure and 9 patients bimaxillary procedure. Bimaxillary procedures overall showed a condyle positional change in pitch from T0 to T1 and T1 to T2 compared to maxillary procedures alone. Condylar translation was stable despite large differences in positioning. Compared to solitary maxillary procedures, bimaxillary procedures showed a statistically significant anterocranial rotation at 1-week follow-up movement (3.95° vs. -0.95°; SD 3,74 vs 1,05; P value = 0.000) and an additional statistically significant anterocranial movement at 1 year after surgery (4.89° vs 0.60°; SD 3,82 vs 0,92; P value = 0.000). In conclusion a need for greater anterocranial stability of the sagittal split osteotomy than that provided by 3 bicortically fixated screws alone might be indicated.
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Affiliation(s)
- Frederik Ohm Buch
- Department of Oral and Maxillofacial Surgery, Odense University Hospital, Denmark
| | - Kasper Stokbro
- Consultant Surgeon & Head of Research, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Oral and Maxillofacial Research Department, Clinical Institute, University of Southern Denmark, Denmark.
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Thamwatharsaree N, Panyarak W, Wantanajittikul K, Yarach U, Tachasuttirut K. Does Articular Disc Position Change Following Mandibular Setback Surgery? J Oral Maxillofac Surg 2024; 82:144-151. [PMID: 37992759 DOI: 10.1016/j.joms.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Maintaining condyle position following bilateral sagittal split ramus osteotomy (BSSO) is crucial to minimizing postoperative relapse. However, the impact of BSSO on the articular disc position remains inconclusive. PURPOSE This study aimed to investigate the changes in articular disc position following setback BSSO surgery. STUDY DESIGN, SETTING, AND SAMPLING In this prospective cohort study, subjects with mandibular prognathism requiring setback BSSO were enrolled between August 2021 and June 2022 at the Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Chiang Mai University, Thailand. Patients with surgical complications, loss of follow-up, or significant artifacts in their MR images were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES The predictor variable was time. The articular disc position was assessed at 3 time points, preoperatively (T0), 3 months postsurgery (T1), and 6 months postsurgery (T2). MAIN OUTCOME The primary and secondary outcome variables were the changes in articular disc position between T0-T2 and T0-T1, respectively. Articular disc position was coded as normal, anterior disc displacement with reduction (ADDwR), anterior disc displacement without reduction (ADDwoR), and anterior disc displacement without reduction and degenerative joint disease (ADDwoR + DJD). COVARIATES Covariate variables collected included age (years), sex (male or female), asymmetry (present or absent), surgical procedure (single jaw (BSSO) or bimaxillary surgery), and setback distance (millimeters). ANALYSES Friedman's test with 80% power and a significance level of 0.05 was employed. Pairwise comparisons were performed using the Dunn-Bonferroni posthoc test to identify statistically significant differences. RESULTS The study included 16 subjects, 6 females and 10 males, with a total of 32 TMJs. Subjects had a mean age of 23.75 (4.57) years. The proportion of TMJs with normal disc position postoperatively increased from 3 (9.4%) to 19 (59.4%). Statistically significant differences were found in the changes in disc position over time (P < .001). CONCLUSIONS Following setback BSSO, the articular discs underwent changes, with a majority of ADDwR cases transitioning to a normal position. Cases with ADDwoR also demonstrated disc reduction capability after surgery. The combined orthodontic treatment and setback BSSO appear to have an effect on articular disc position in skeleton class III patients.
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Affiliation(s)
- Nathakarn Thamwatharsaree
- Graduate Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Wannakamon Panyarak
- Assistant Professor, Division of Oral and Maxillofacial Radiology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Kittichai Wantanajittikul
- Assistant Professor, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Uten Yarach
- Lecturer, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kathawut Tachasuttirut
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
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Voss JO, Bolis R, Koerdt S, Doll C, Rubarth K, Duda GN, Heiland M, Fischer H, Rendenbach C, Ebker T, Steffen C. Quantifying bone healing after mandibular displacement in orthognathic surgery. Br J Oral Maxillofac Surg 2024; 62:45-50. [PMID: 38008679 DOI: 10.1016/j.bjoms.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/13/2023] [Indexed: 11/28/2023]
Abstract
Impaired bony healing following bilateral sagittal split osteotomy (BSSO) is a major unmet medical need for affected patients, and rare occurrences can hinder the identification of underlying risk factors. We hypothesised that osseous union following BSSO can be quantified using volumetric analysis, and we aimed to identify the risk factors for impaired bone healing. The percentage change in bony volume was measured in orthognathic patients following BSSO using two consecutive postoperative cone-beam computed tomography scans. Patients' characteristics and treatment parameters were documented, and correlation and regression analyses of these variables performed. Thirty-six patients (23 men and 13 women) with a mean (SD) age of 33.28 (11.86) years were included. The gap site (lingual versus buccal) (p < 0.01) had a significant impact on the change in volume. Age (p = 0.06) showed a trend towards significance. Initial width of the osteotomy gap, sex, and indication for surgery did not influence osseous healing. Increased age at surgery and the side of the buccal osteotomy are independent risk factors for impaired osseous healing following BSSO.
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Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.
| | - Rwis Bolis
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Kerstin Rubarth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute and Berlin Institute of Health Centre for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Heilwig Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Rendenbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tobias Ebker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Claudius Steffen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
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Merta M, Kiukkonen A, Leikola J, Stoor P, Suojanen J. Skeletal stability after mandible bilateral sagittal split osteotomy - comparison of patient-specific implant and mini-plate fixation: A retrospective study. J Craniomaxillofac Surg 2024; 52:93-100. [PMID: 38129183 DOI: 10.1016/j.jcms.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 09/24/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of the study was to compare the stability of the virtual surgical planning (VSP) and computer-aided design accompanied by patient-specific implants (PSIs) and conventional mini-plates in mandible advancement with bilateral sagittal split osteotomy (BSSO). This retrospective study evaluates the clinical and cephalometric records of 53 patients (12 male, 41 female) treated with BSSO in Helsinki University Hospital. Subjects were divided into two groups: VSP-PSI (21 patients: 4 male and 17 female; mean age 38 years, range 25-53 years); and conventional wafer-based repositioning with mini-plate fixation (32 patients: 8 male and 24 female; mean age 39 years, range 21-56 years). The effect of the amount and direction of the advancement on the stability was also analysed individually. The standardized lateral cephalometric radiographs in three time points were analysed to compare the groups. After surgery (T2), there were no differences between groups in cephalometric variables. During follow-up (T2-T3), the cephalometric variables in both Groups A and B were stable, so there was no difference in stability between the VSP-PSI and the conventional mini-plate groups. During follow-up, the mandibles rotated clockwise or counterclockwise, relapsed towards their original direction, and the changes were statistically significant (jaw relationship; p = 0.018, soft tissue profile; p = 0.025); when the advancement of mandible was >6 mm, the increase in gonial angle compared to mandibles advanced ≤6 mm was statistically significant (p = 0.03). VSP-PSI and conventional mini-plate fixation can be considered equally stable. Large advancements with counterclockwise rotation regardless of fixation method are more susceptible to relapse. VSP-PSI alone cannot solve the relapse-related concerns in mandible osteotomy.
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Affiliation(s)
- Minna Merta
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti, Finland.
| | - Anu Kiukkonen
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patricia Stoor
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, Finland
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti, Finland; Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Meral SE, Koç O, Tosun E, Tüz HH. Effects of sagittal split Ramus osteotomy on condylar position and Ramal orientation in patients with mandibular asymmetry. Clin Oral Investig 2023; 28:65. [PMID: 38158456 DOI: 10.1007/s00784-023-05400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. METHODS A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups. RESULTS Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively). CONCLUSIONS SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. CLINICAL RELEVANCE Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.
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Affiliation(s)
- Salih Eren Meral
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey.
| | - Onur Koç
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Emre Tosun
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Hakan H Tüz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
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da Hora Sales PH, Maffìa F, Vellone V, Ramieri V, Leão JC. Is it necessary to use bone grafts to prevent defects at the lower border of the mandible after mandibular advancement?-a systematic review. Oral Maxillofac Surg 2023; 27:581-589. [PMID: 36107287 DOI: 10.1007/s10006-022-01112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Defects in the lower border of the mandible may represent an aesthetic problem after mandibular advancement in orthognathic surgery. The use of bone grafts has been reported in the literature as a possibility to reduce these defects in the postoperative period. OBJECTIVE The objective of this systematic review is to answer the following research question: Is it necessary to use bone grafts to prevent defects at the lower border of the mandible after mandibular advancement? METHODS The literature search was conducted on MEDLINE via PubMed, Scopus, Central Cochrane, Embase, LILACS, and Sigle via Open Gray up until December 2020. Five studies were eligible for this systematic review, considering the previously established inclusion and exclusion criteria. RESULTS 1340 mandibular osteotomies were evaluated, with a mean advance of 8 mm, being 510 with bone graft (42 defects), 528 without graft (329 defects), and 302 with an alternative technique (32 defects). Regarding the type of bone graft used, three articles used xenogenous or biomaterial grafts and two allogenous bone grafts. The results of the meta-analysis showed a reduction in the presence of defects in the bone graft group: OR 0.04, 95% CI = 0.01, 0.19; p = 0.0005, (I2 = 87%; p < 0.0001). CONCLUSION The use of bone grafts seems promising in reducing defects in the lower border of the mandible after mandibular advancement. New controlled prospective studies with a larger number of participants are needed to ensure the effectiveness of this procedure.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Department of Prothesis and Oral and Maxillofacial Surgery Department, Postgraduate Program in Dentistry, Federal University of Pernambuco, Av. Prof. Moraes Rego 1235 - Cidade Universitária, Recife, PE, 50670-901, Brazil.
| | - Francesco Maffìa
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Valentino Vellone
- Department of Maxillofacial Surgery, S. Maria Hospital, Terni, Italy
| | | | - Jair Carneiro Leão
- Department of Clinical and Preventive Dentistry, Dental School, Federal University of Pernambuco, Recife, PE, Brazil
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Al-Dawoody AD, Hamad SA, Kheder Khrwatany KA, Saleem TH. Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy? Head Face Med 2023; 19:49. [PMID: 37936216 PMCID: PMC10629200 DOI: 10.1186/s13005-023-00396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
AIM The purpose of this study was to evaluate the effect of adding a fourth osteotomy at the lower border of the mandible on the lingual cortical fracture pattern in bilateral sagittal split ramus osteotomies. PATIENTS AND METHODS The sample of the study consisted of 20 patients (12 male and 8 female, with a mean age of 26.79 ± 7.12 years) with mandibular deformities who needed bilateral sagittal split ramus osteotomy. One side underwent a traditional sagittal split ramus osteotomy, and the procedure was modified on the other side by adding a 1 cm horizontal osteotomy at the lower border of the mandible, just distal to the caudal end of the vertical buccal osteotomy cut. A 3D CBCT was used to identify the split pattern. RESULTS In the total sample, 40% of the lingual splits ran vertically toward the lower border of the mandible (LSS1), 20% of the splits passed horizontally to the posterior border of the mandible (LSS2), 32.5% of the splits took place along the inferior alveolar canal (LSS3), and 7.5% of the splits were unfavourable fractures (LSS4). On the inferior border osteotomy sides, the distribution of LSS1, LSS2, LSS3, and LSS4 was 10 (25%), 6 (15%), 4 (10%), and 0 (00), respectively. Their distribution on the sides without inferior border osteotomy was 6 (15%), 8 (20%), 13 (32.5%), and 3 (7.5%), respectively. Statistical analysis revealed a significant difference between the two groups (p < 0.05). CONCLUSION Inferior border osteotomy tends to direct the lingual split fracture line toward the lower and posterior borders of the mandible and minimizes bad splits; however, further studies are needed to confirm our findings.
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Altuncu F, Kazan D, Özden B. Comperative evaluation of the current and new design miniplate fixation techniques of the advanced sagittal split ramus osteotomy using three-dimensional finite element analysis. Med Oral Patol Oral Cir Bucal 2023; 28:e553-e561. [PMID: 37823299 PMCID: PMC10635628 DOI: 10.4317/medoral.25964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/24/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the stress occurring in the fixation systems both developed in various geometric designs for this study and currently used in sagittal split ramus advancement osteotomy using finite element analysis. MATERIAL AND METHODS The finite element model that imitates three-dimensional sagittal split advancement osteotomy was fixed in 10 different miniplate fixation methods: one miniplate fixed with four monocortical screws in a horizontal and oblique pattern; four-hole two miniplates with eight monocortical screws; five-hole miniplate fixed with four monocortical and one bicortical screws; six-hole straight and curved miniplates fixed with six monocortical screws in different geometric designs. Unilateral masticatory muscle loads that have previously determined in the literature were applied to the model at the anatomical muscle attachment regions and the data obtained from finite element analysis and static linear analysis methods were recorded as Von mises, maximum principle and minimum principle stress values. RESULTS It was observed from the results that maximum stress occurred in Group 1, which consisted of double backward T-shaped miniplate with 6-holes and, minimum stress occured in group 10, which mimiced hybrid system with one miniplate and four monocortical and one bicortical screws. CONCLUSIONS Based on our results, the stress on the miniplates changes according to the geometric designs and the stress on the miniplate decreases as the numbers of miniplates and bars increase. The hybrid miniplate may be preferred by the surgeon as it will be exposed to less stress in excessive mandibular advancements by using the advantages of both the miniplate and the bicortical screw.
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Affiliation(s)
- F Altuncu
- Bahcesehir University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery Gayrettepe, Cam Han Binası Barbaros Blv. No: 153, 34357, Beşiktaş, İstanbul
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sakane K, Hasegawa S, Nakao H, Sasaki J, Miyachi H, Nagao T. Factors affecting progressive facial swelling immediately after orthognathic surgery: A retrospective cohort study. J Craniomaxillofac Surg 2023; 51:692-695. [PMID: 37816659 DOI: 10.1016/j.jcms.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 08/27/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
The aim of this study was to identify clinical factors associated with progressive facial swelling after orthognathic surgery. Patients diagnosed with jaw deformities and undergoing orthognathic surgery were retrospectively evaluated, and those with surgical site infection, Le Fort I osteotomy, or genioplasty only were excluded. Facial swelling volume was calculated by comparing facial volume preoperatively and three days postoperatively using 3D images and image analysis software (VECTRA H2). FXIII was measured within three days after surgery in only patients with unexplained postoperative bleeding or hematoma. The correlation between facial swelling volume and clinical factors was statistically analyzed. Facial swelling volume was examined in 78 patients. Univariate analysis showed a significant difference between facial swelling volume (mean = 41.6 cm3) and operation time (mean = 209.3 min, r = 0.283, p = 0.012), ΔHb level (mean = 1.18 g/dL, r = 0.235, p = 0.039), as well as decreased factor XIII activity (mean = 75.3%, p = 0.012). Multivariate analysis showed a significant difference between facial swelling volume and FXIII deficiency (standard error = 6.44, p = 0.031).Progressive facial swelling immediately after orthognathic surgery may be due to factor XIII deficiency.
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Affiliation(s)
- Kaori Sakane
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-Dori, Chikusa, Nagoya, Aichi, 464-8651, Japan
| | - Shogo Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-Dori, Chikusa, Nagoya, Aichi, 464-8651, Japan.
| | - Hiroaki Nakao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-Dori, Chikusa, Nagoya, Aichi, 464-8651, Japan
| | - Jun Sasaki
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-Dori, Chikusa, Nagoya, Aichi, 464-8651, Japan
| | - Hitoshi Miyachi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-Dori, Chikusa, Nagoya, Aichi, 464-8651, Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-11 Suemori-Dori, Chikusa, Nagoya, Aichi, 464-8651, Japan
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Toplu G, Altinel D, Evin ŞG, Yiğit E, Toplu SG, Serin M. Impact of Different Osteotomy Techniques on Bone Reserve in the Osteotomy Line in Sagittal Split Osteotomy: Experimental In Vitro Study in Caprine Mandible Model. J Craniofac Surg 2023; 34:e785-e788. [PMID: 37646346 DOI: 10.1097/scs.0000000000009656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE The objective of this study was to investigate of the effect of piezzo and conventional osteotomy techniques on bone reserve in the osteotomy line and comminuted fracture ratios that is able to compromise bone to bone contact negatively. METHODS Bilateral sagittal split ramus osteotomy was performed on 12 fresh male Thracian curly caprine mandible. In the first group (n: 12) osteotomies were performed with piezzo device. In the second group (n: 12) osteotomies were performed with micromotor and manual osteotomes. Operative time was measured. The number of comminuted fractures, length and width of the osteotomy, and the space between the osteotomy lines was evaluated from 3-dimensional computed tomography scans. RESULTS The mean value of procedure duration was 320.4±10.76 seconds for piezo osteotomy and 238.8±8.29 seconds for conventional micromotor ( P <0.0001). Number of comminuted fractures was 1.41±1.3 in piezoelectric group, 1.5±1.3 in conventional group and the difference was not statistically significant (p: 0,88). Osteotomy lengths and widths were 35.58±5.2, 2.196±1.9 and 36.23±5.05, 2.27±1.85 in the piezzo and conventional groups, respectively. (p lengths :0,75; p widths :0,92) The volume of the bony interface between the distal and proximal segments of the mandible after osteotomy was 166.3±184.2 mm 3 in the piezzo group and 163.5±129.3 mm 3 in the conventional group (p: 0,96). CONCLUSION The piezo surgery and the conventional osteotomy were found to be similar in terms of the gap between the distal and proximal mandible and the number of comminuted fractures. The duration to perform the conventional osteotomy was found to be shorter than the piezo surgery.
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Affiliation(s)
| | - Dinçer Altinel
- Health Sciences University, Istanbul Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Department
| | - Şeyda Güray Evin
- Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Department
| | - Enes Yiğit
- Health Sciences University, Istanbul Training and Research Hospital, Ear, Nose and Throat Department, Istanbul, Turkey
| | | | - Merdan Serin
- Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Department
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Jiang Y, Yang Z, Qi Y, Peng J, Li Z, Liu X, Yi B, Wang X, Chen G, Han B, Xu T, Jiang R. Early and 1-year postsurgical stability and its factors in patients with complicated skeletal Class Ⅲ malocclusion treated by conventional and surgery-first approach: A prospective cohort study. Am J Orthod Dentofacial Orthop 2023; 164:728-740. [PMID: 37516951 DOI: 10.1016/j.ajodo.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION This study aimed to compare postsurgical stability between conventional (CSA) and surgery-first (SFA) approaches and investigate its prognostic factors in patients with a skeletal Class Ⅲ extraction. METHODS Twenty and 19 patients treated with LeFort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) with premolar extraction were enrolled in SFA and CSA groups, respectively. Serial cone-beam computed tomography images obtained before surgery, immediately after surgery (T1), 3 months after surgery, and 12 months after surgery were used for 3-dimensional quantitative analysis. The condyle was segmented for analyzing volumetric changes. Repeated measures analysis of variance, independent t test, and chi-square test were used to compare time-course and intergroup differences. Pearson and Kendall correlation and multivariate linear regression analyses were used to explore prognostic factors affecting skeletal stability. RESULTS In both CSA and SFA, postsurgical relapse mainly occurred in the mandible sagittal and vertical dimensions and during the first 3 months after surgery. Stability in SFA was significantly less than that in CSA. Intraoperatively, inferolateral condylar displacement with proximal segment inwards, clockwise rotation, and return movements after surgery were observed regardless of the treatment approach. The condylar volume remained stable over time. Multivariate regression analysis showed that posterior vertical dimension (VD) at T1 (-1.63 mm), surgical amount of mandibular setback (-10.33 mm), surgical condylar downwards displacement (-1.28 mm), and anterior overjet at T1 (6.43 mm) were the most important predictors of early mandibular relapse (r2 = 0.593). CONCLUSIONS The risk of early relapse could be reduced by controlling the anterior, middle, and posterior constraints provided by the prediction model.
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Affiliation(s)
- Yiran Jiang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhongpeng Yang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yuhan Qi
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jiale Peng
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zili Li
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaojing Liu
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Biao Yi
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoxia Wang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gui Chen
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tianmin Xu
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
| | - Ruoping Jiang
- Department of Orthodontics, NHC Research Center of Engineering and Technology for Computerized Dentistry, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
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Khaleel AA, Bede SY. Evaluation of the Lingual Splitting Patterns and the Lateral Bone Cut Ends Following Mandibular Bilateral Sagittal Split Osteotomy Using Cone Beam Computed Tomography (CBCT). J Craniofac Surg 2023; 34:e728-e731. [PMID: 37316983 DOI: 10.1097/scs.0000000000009477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/25/2023] [Indexed: 06/16/2023] Open
Abstract
The bilateral sagittal split osteotomy (BSSO) is the most popular orthognathic procedure performed by maxillofacial surgeons to treat skeletal class II and class III and to correct mandibular asymmetries. The study aimed to evaluate the lingual splitting patterns and lateral bone cut end (LBCE) in bilateral sagittal split osteotomy (BSSO) and their relation with the ramal thickness and the presence of impacted third molars using cone beam computed tomography (CBCT). This prospective observational study included patients with mandibular prognathism who were treated with BSSO with or without Le Fort I osteotomy. Cone beam computed tomography was used to measure the ramal thickness preoperatively and to evaluate the LBCE, and the lingual splitting patterns postoperatively. Twenty-one patients (42 sides) were included in this study. The most commonly observed lingual splitting pattern was type III (47.6%), while the most common LBCE was type B (59.5%). The bad split was encountered 8 times on 42 sides (16.7%). A nonsignificant relationship between the ramal thickness and bad splitting was observed ( P =0.901). Impacted third molars were present in 16 of the 42 sides (38.1%) and had no significant effect on the occurrence of bad splitting ( P =0.063). Type III lingual splitting pattern and type B LBCE were the most commonly observed patterns. No direct association was observed concerning the presence of impacted mandibular third molars and the thickness of the ramus with the occurrence of bad splitting.
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Affiliation(s)
- Ameen A Khaleel
- Al-Yarmouk Teaching Hospital, The Iraqi Board for Medical Specializations
| | - Salwan Y Bede
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad and The Iraqi Board for Medical Specializations, Baghdad, Iraq
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Yan JY, Lin YJ, Li YX, Lao A, Liao SH, Liu JQ. [Morphological changes of upper airway in patients with skeletal Class Ⅲ malocclusion after bimaxillary surgery and correlation analysis]. Shanghai Kou Qiang Yi Xue 2023; 32:485-490. [PMID: 38171517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE To analyze the morphological changes of the upper airway and related influencing factors in patients with skeletal Class Ⅲ malocclusion after bimaxillary surgery. METHODS Twenty skeletal Class Ⅲ patients who underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy(BSSRO) for maxillary advancement and mandibular setback were selected. The patients received CT scans before(T0) and 3-6 months after surgery, and the images were reconstructed three-dimensionally with Dolphin Imaging 11.9 software. Changes in the volume, cross-sectional area, and landmarks of each soft and hard tissue of the airway were measured. Statistical analysis of the data was performed using SPSS 25.0 software package. RESULTS The volume of nasopharyngeal airway increased after operation (P<0.05), and the volume of oropharyngeal airway decreased significantly(P<0.01). The cross-sectional area of the airway at the plane of the second cervical vertebra was significantly decreased (P<0.01), and the coronal and sagittal diameters were decreased(P<0.05). The change of nasopharyngeal airway volume was moderately positively correlated with the sagittal change of the posterior nasal spine (r=0.460, P<0.05), and the change of oropharynx and laryngopharyngeal airway volume was positively correlated with the vertical change of the midpoint of the soft palate(r=0.496, 0.696, P<0.05). The airway cross-sectional area in the second and third cervical vertebra planes and the sagittal diameter of the airway in the third cervical vertebra plane were positively correlated with the vertical changes of the midpoint of the soft palate(r=0.474, 0.629, 0.547, P<0.05). The change of airway cross-sectional area at the third cervical vertebra plane was moderately negatively correlated with the change of mandibular plane angle(r=-0.536, P<0.05). CONCLUSIONS The volume and cross-sectional area of oropharyngeal airway in skeletal Class Ⅲ patients after bimaxillary surgery will decrease. However, the total upper airway volume doesn't change significantly. The changes in the upper airway are correlated with the changes in some soft and hard tissue landmarks.
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Affiliation(s)
- Jie-Ya Yan
- 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 Research Institute of Stomatology. Shanghai 200011, China. E-mail:
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Luo YX, Chen ZH, Wang JN. Changes of Temporomandibular Joint Morphology and Symptoms in Class II Malocclusion Patients With Bilateral Sagittal Split Ramous Osteotomy. J Craniofac Surg 2023; 34:e655-e660. [PMID: 37801718 DOI: 10.1097/scs.0000000000009505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/16/2023] [Indexed: 10/08/2023] Open
Abstract
This study included 46 patients with class II malocclusion ranging in age from 19 to 39 years old treated with bilateral sagittal split ramous osteotomy (BSSRO). Left and right temporomandibular joints (TMJs) of each subject were evaluated independently with cone-beam computed tomography (CBCT) before operation (T1), 1 week after operation (T2), and 1 year after operation (T3) and assessed the effects of orthognathic surgery (OGS) on the temporomandibular joint disease (TMD) symptoms. Temporomandibular joint morphology evaluation included condylar volume, condylar area, cortical bone thickness, depth of the mandibular fossa, fossa thickness, joint nodule angle, joint space, and condyle-fossa relationship, which were calculated by using the Mimics software and 3-matic software. Data were statistically analyzed with SPSS software (P <0.05 means statistically significant). In our study, bilateral TMJs have no difference in T3. Bilateral sagittal split ramous osteotomy had no significant effect on the articular fossa. The condyle volume and surface area decreased from T1 to T3, but the cortical thickness of the bone did not change significantly. More anterior condyle positions in T1 and more posterior in T3.21 patients had at least 1 sign or symptom of TMD in T1 and 27 patients in T3. Four patients who were asymptomatic in T1 developed pain after surgery, 10 developed noises, 12 showed limited mouth opening, and 8 had abnormal opening patterns. It is concluded that more condylar posterior position after BSSRO and the reduction of condyle may be related to the enlargement of anterior space. The number of patients with joint symptoms increased postoperative, and the impact of BSSRO on TMD may be negative.
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Affiliation(s)
- Yang-Xin Luo
- Guangdong Provincial Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, P.R. China
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Hattori Y, Murali SP, Lo LJ. Avoiding Inferior Alveolar Nerve Injury During Sagittal Split Ramus Osteotomy. J Craniofac Surg 2023; 34:e706-e708. [PMID: 37622543 DOI: 10.1097/scs.0000000000009688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Orthognathic surgery is highly effective in improving overall facial esthetics, in addition to achieving an ideal occlusion. Sagittal split ramus osteotomy (SSRO) of the mandible is the mainstay of modern orthognathic surgery, but intraoperative injury to the inferior alveolar nerve (IAN) remains one of the common complications. The authors report a case of 19-year-old male patient with left cleft lip and palate who received orthognathic surgery involving SSRO. The patient's right IAN ran close to the outer cortex of the mandible, but SSRO was successfully performed without injuring the nerve. Detailed preoperative evaluation using computed tomography images is essential. Blind splitting maneuvers during SSRO may cause IAN injury, and direct visualization inside the ramus helps to prevent injury to the nerve. Sagittal split ramus osteotomy could be considered as a viable option even when the IAN runs close to the outer cortex. This article describes SSRO procedures, highlighting the methods to avoid nerve injury.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Srinisha P Murali
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital
- Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
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Wang L, Wang Y, Sun X, Chen K, Pang W, Gao Y, Zhu Z, Wu G. A Novel Technique for Resection and Reconstruction of the Temporomandibular Joint by Sliding Vertical Ramus Osteotomy using Only Submandibular Approach. J Craniofac Surg 2023; 34:2163-2167. [PMID: 37291710 DOI: 10.1097/scs.0000000000009408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/19/2023] [Indexed: 06/10/2023] Open
Abstract
In this paper, an innovative technique for resection and reconstruction of the temporomandibular joint by sliding vertical ramus osteotomy using only a submandibular approach is presented. Before pulling the posterior mandibular border slightly downward to expose parts of the condyle, the vertical ramus osteotomy was performed. With the help of 3D simulation and surgical templates, the condylectomy was carried out using the ultrasonic osteotome through the submandibular approach. Our technique achieved the desired results while preventing complications of facial nerve paralysis, the occurrence of Frey syndrome, and the preauricular scar. Therefore, we suggest that this surgical method represents an alternative treatment option for temporomandibular joint lesions.
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Affiliation(s)
- Lin Wang
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Yingtong Wang
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Xiumei Sun
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Kai Chen
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Wanyu Pang
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Yisu Gao
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Zihe Zhu
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Guomin Wu
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
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Telha W, Bi R, Abotaleb B, Al-Watary M, Sakran K, Zhu S, Jiang N. Condylar positional changes and remodeling following bimaxillary anterior segment osteotomy with and without Le Fort I osteotomy: a three-dimensional comparative analysis. Clin Oral Investig 2023; 27:5121-5130. [PMID: 37474831 DOI: 10.1007/s00784-023-05132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To evaluate 3D condylar displacement and long-term remodeling following the correction of bimaxillary protrusion by anterior segment osteotomy (ASO) with and without Le Fort I surgery. MATERIALS AND METHOD This retrospective study included 32 adults with bimaxillary protrusion who underwent ASO alone (group 1) or with concomitant Le Fort I osteotomy (group 2). Subject's computed tomography scans at basic (T0), immediate postoperatively (T1), and at 1 year or more follow-up (T2) were collected. The condyle displacement was measured at superior-inferior, lateromedially, and anteroposterior surfaces, while condyle remodeling was measured at the superior, lateral, anterior, medial, and posterior surfaces. All 3D analyses were performed using 3D Slicer software (4.11.2). RESULTS At T1, 52.7%, 86.7%, and 94.4% of condyles in group 1 were displaced inferiorly, laterally, and posteriorly, respectively, as well as 75%, 89.2%, and 53.5% of condyles in group 2, which had not fully returned to the original preoperative positions at T2. Condylar remodeling was observed in both groups at T2, and no significant difference was found in the overall condylar volume between T1 and T2 in both groups. Patients in group 2 exhibited significant bone resorption at both lateral and anterior surfaces compared to group 1 (P = 0.000 and 0.01, respectively). CONCLUSION This study's results demonstrated that ASO is associated with a degree of condylar changes even if the posterior mandible is not osteomized. The positional changes vary between bimaxillary ASO alone and those with simultaneous Le Fort I osteotomy. However, both groups' condyle volume remained stable at the long-term follow-up.
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Affiliation(s)
- Wael Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Rui Bi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Bassam Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Mohammed Al-Watary
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
| | - Karim Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China.
| | - Nan Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China.
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Çolak S, Altan A, Bayrak S, Akbulut N. Evaluation of bony changes observed in mandibular osteotomy lines and mandibular condyles following bilateral sagittal ramus osteotomy by fractal analysis. Oral Maxillofac Surg 2023; 27:519-526. [PMID: 35831722 DOI: 10.1007/s10006-022-01101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the surgically impacted trabecular changes in mandibular osteotomy lines and mandibular condyles after bilateral sagittal split ramus osteotomy using the fractal analysis method. MATERIALS AND METHOD The study population consisted of 30 patients (9 male, 21 female) diagnosed with mandibular prognathism and operated with bilateral sagittal split ramus osteotomy under general anesthesia. Fractal analyses observed the alterations on the trabecular structure of osteotomy lines, and mandibular condyles on panoramic radiographs obtained preoperatively, postoperatively, 1st week, 6th month, and 12th month. The box-counting method was used to evaluate the changes in trabecular structure by fractal analysis. P-values of less than 0.05 were considered significant. RESULTS The fractal dimension values in both osteotomy lines and mandibular condyles were significantly decreased on postoperative 1st week regarding preoperative values. However, fractal dimension values commenced increasing in the following postoperative period. The fractal dimension values of the horizontal and vertical osteotomy lines reached their preoperative values on postoperative 6th and 12th month, respectively. The decreased fractal dimension values observed in the early postoperative period in the right and left condyles reached their preoperative values at the 6th postoperative month. CONCLUSION Fractal analyses performed postoperatively can provide information about trabecular changes and bone healing of structures such as osteotomy lines directly affected by bilateral sagittal split ramus osteotomy and indirectly affected mandibular condyles. The results support that fractal analysis can be used together with clinical data in the evaluation of bone healing process.
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Affiliation(s)
- Sefa Çolak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpasa University, Kaleardi Mahallesi, Muhittin Fisunoglu Caddesi, Omcalik Sokak, Ali Sevki Erek Yerleskesi Dis Hekimligi Fakültesi, Merkez, Tokat, 60030, Turkey.
| | - Ahmet Altan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Konya Necmettin Erbakan University, Beysehir Caddesi, Baglarbası Sk, Meram, Konya, 42090, Turkey
| | - Seval Bayrak
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Abant Izzet Baysal Universitesi Dis Hekimligi Fakultesi, Golkoy Kampusu, Bolu, Turkey
| | - Nihat Akbulut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpasa University, Kaleardi Mahallesi, Muhittin Fisunoglu Caddesi, Omcalik Sokak, Ali Sevki Erek Yerleskesi Dis Hekimligi Fakültesi, Merkez, Tokat, 60030, Turkey
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Zhang C, Wang HW, Li B, Cao J, Wang X, Wang XD. [Three-dimensional comparative study on the stability of bimaxillary simultaneous genioplasty and simple genioplasty]. Shanghai Kou Qiang Yi Xue 2023; 32:380-384. [PMID: 38044731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
PURPOSE To establish a three-dimensional method to evaluate whether there is a difference in stability between bimaxillary simultaneous genioplasty and simple genioplasty. METHODS This study was a retrospective study. Sixty patients who underwent genioplasty were selected. They were divided into bimaxillary simultaneous genioplasty group (n=30) and simple genioplasty group (n=30). The spiral CT data of patients at 2 months before operation (T0), 7 days after operation (T1) and 12 months after operation (T2) were collected, reconstructed and separated, and the three-dimensional model of maxilla and mandible was obtained. A three-dimensional analysis method of stability was established by 3D-matching. Recurrences in three-dimensional space 12 months after surgery were analyzed in two groups of patients. Statistical analysis of the data was performed with SPSS 26.0 software package. RESULTS In simple genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.54±0.38) mm, and the sagittal recurrence rate was 12.27%. In bimaxillary simultaneous genioplasty, the maximum amount of the chin recurrence was sagittal backward recurrence (0.60±0.31) mm, and the sagittal recurrence rate was 12.96%. Rotation occurred in both groups 12 months after operation, which was 1.98±2.70° in the simple genioplasty group and 1.01±1.61° in the bimaxillary simultaneous genioplasty group(P<0.05). There was no significant difference in the sagittal movement of the chin between the two groups, and in the sagittal recurrence(P>0.05). CONCLUSIONS The three-dimensional method established in this study can be used to evaluate the stability after genioplasty. The recurrence after genioplasty mainly occurred in the sagittal direction. The rotation trend of chin after genioplasty is worthy of attention. There was no increased risk for bimaxillary simultaneous genioplasty.
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Affiliation(s)
- Chen Zhang
- Shanxi Medical University, School and Hospital of Stomatology. Taiyuan 030001, Shanxi Province, China. E-mail:
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Hattori Y, Uda H, Niu A, Yoshimura K, Sugawara Y. Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery. Int J Oral Maxillofac Surg 2023; 52:476-480. [PMID: 36100528 DOI: 10.1016/j.ijom.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022]
Abstract
The sagittal split ramus osteotomy (SSRO) has been performed mainly on an inpatient basis because of the duration of anaesthesia and the potential risk of postoperative complications, such as bleeding, pain, nausea, and vomiting. However, advances in both surgical and anaesthetic management have enabled the reduction of these risks and shortened the length of hospital stay. Thus, the SSRO may be feasible even in the ambulatory setting in elective cases. The clinical records of all patients who underwent an outpatient SSRO between August 2011 and September 2020 at Lilla Craniofacial Clinic were reviewed retrospectively. Data on age, sex, duration of surgery, operative procedures, intraoperative bleeding, and admission status were investigated. In total, 143 patients underwent a bilateral SSRO. The SSRO was performed as an isolated procedure in 73 patients and concomitantly with other surgical procedures in the remaining 70 patients. Overall, 142 of the 143 patients were discharged on the day of surgery (99.3%); only one (0.7%) required an overnight stay because of a submental haemorrhage after genioplasty. No emergency hospitalizations or readmissions occurred after discharge. Multimodal perioperative management, both surgical and anaesthetic, facilitated enhanced patient recovery after surgery, and SSRO was performed successfully and safely as an ambulatory procedure.
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Affiliation(s)
- Y Hattori
- Department of Plastic Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
| | - H Uda
- Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan; Lilla Craniofacial Clinic Tokyo, Chuo-ku, Tokyo, Japan.
| | - A Niu
- Department of Plastic Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
| | - K Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Y Sugawara
- Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan; Lilla Craniofacial Clinic Tokyo, Chuo-ku, Tokyo, Japan
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Miura KI, Yoshida M, Rokutanda S, Koga T, Umeda M. Swallowing Functions after Sagittal Split Ramus Osteotomy with Loose Fixation for Mandibular Prognathism: A Retrospective Case Series Research. Int J Environ Res Public Health 2023; 20:1926. [PMID: 36767291 PMCID: PMC9916000 DOI: 10.3390/ijerph20031926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Sagittal split ramus osteotomy (SSRO) is a standard surgical technique for patients with mandibular prognathism. However, the appropriate position of the proximal fragment is not strictly defined, and rigid fixation can induce early postoperative skeletal relapse and temporomandibular (TMJ) disorders. Loose fixation can be expected to seat the proximal bone fragments in a physiologically appropriate position, thereby reducing adverse events. Although long-term skeletal stability has been achieved using SSRO without fixation, the evaluation of preoperative and postoperative eating and swallowing functions remains unclear, and this study aimed to clarify this point. We evaluated mastication time, oral transfer time, and pharyngeal transfer time using videofluorography (VF) preoperatively, two months postoperatively, and six months postoperatively, and along with the position of anatomical landmarks using cephalometric radiographs, modified water swallowing test (MWST), food test (FT), and repetitive saliva swallowing test (RSST) were used to evaluate postoperative swallowing function. Four patients (one male, three females; mean (range) age 26.5 (18-51) years) were included, with a mean setback of 9.5 mm and 6.5 mm on the right and left sides, respectively. Postoperative eating and swallowing functions were good in VF, cephalometric analysis, MWST, FT, and RSST. In the present study, good results for postoperative eating and swallowing functions were obtained in SSRO with loose fixation of the proximal and distal bone segments.
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Affiliation(s)
- Kei-ichiro Miura
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
- Department of Oral Surgery, Imakiire General Hospital, Kagoshima 890-0051, Japan
| | - Masashi Yoshida
- Department of Oral Surgery, Imakiire General Hospital, Kagoshima 890-0051, Japan
| | - Satoshi Rokutanda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
- Department of Dentistry and Oral Surgery, Juko Memorial Nagasaki Hospital, Nagasaki 852-8004, Japan
| | - Takamitsu Koga
- Department of Oral Surgery, Imakiire General Hospital, Kagoshima 890-0051, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
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Peleg O, Mahmoud R, Shuster A, Arbel S, Kleinman S, Mijiritsky E, Ianculovici C. Vertical Ramus Osteotomy, Is It Still a Valid Tool in Orthognathic Surgery? Int J Environ Res Public Health 2022; 19:10171. [PMID: 36011805 PMCID: PMC9407762 DOI: 10.3390/ijerph191610171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study is to evaluate mandibular osteotomy procedures during orthognathic surgery, with an emphasis on the complications of the two leading procedures: intraoral vertical ramus osteotomy (IVRO) and sagittal split osteotomy (SSO). We conducted a retrospective cohort study by extracting the records of patients who underwent either IVRO or SSO procedures during orthognathic surgery in a single center between January 2010 and December 2019. A total of 144 patients were included (median age of 20.5 years, 52 males). The IVRO:SSO ratio was 118:26 procedures. When referring to all surgeries performed, IVRO procedures were associated with shorter hospitalization than the SSO procedures, while the overall durations of surgery and follow-up periods were comparable. In contrast, when referring only to bimaxillary procedures, the duration of the IVRO bimaxillary procedures was significantly shorter than the SSO bimaxillary procedures. There were 53 complications altogether. Postoperative complications consisting of skeletal relapse, temporomandibular joint dysfunction, sensory impairment, and surgical-site infection were significantly fewer in the IVRO group. Both types of osteotomies have acceptable rates of complications. IVRO appears to be a safer, simpler, though less acceptable procedure in terms of patient compliance.
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Affiliation(s)
- Oren Peleg
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Reema Mahmoud
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amir Shuster
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shimrit Arbel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shlomi Kleinman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Eitan Mijiritsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Clariel Ianculovici
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Yazar L, Aydil BA, Ayhan M, Çömlekçioğlu Y. Comparison of standard miniplates and locked miniplates in post-traumatic fracture stabilization. ULUS TRAVMA ACIL CER 2022; 28:715-722. [PMID: 35652876 PMCID: PMC10443005 DOI: 10.14744/tjtes.2022.59447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bicortical screws (lag and positional) or miniplates with monocortical screws are generally used for the rigid fixa-tion of the sagittal split ramus osteotomy (SSRO) in maxillofacial surgery. However, in this osteosynthesis method, the plate must be perfectly adapted to the bone to prevent misalignment of the bone segment and occlusal changes. In addition, it is necessary to prevent the position of the condyle in the mandibular fossa from changing after fixation. In recent years, locked miniplate systems have been used to overcome these complications. METHODS The aim of this study is to compare the commonly used 2.0 mm standard miniplate/screw systems and 2.0 mm locking miniplate/screw systems in fresh sheep jaws with Obwegeser-Dal Pont (OD) and Hunsuck-Epker (HE) modifications, by evaluating standard parameters. RESULTS Our study consists of two main groups and two subgroups. 40 sheep hemimandibulae were randomly divided into two main groups. Each group was randomly divided into two subgroups. There are ten hemimandibulae (n=10) in each subgroup. Linear force test was applied using 4-hole standard miniplate and 4-hole locking miniplate systems on sheep jaws with 5 mm advancement by applying OD and HE techniques, which are two frequently preferred modifications in SSRO. For statistical analysis SPSS® 16.0 (Sta-tistical Package for the Social Sciences, SPSS Inc. Chicago, Illinois, USA) package program was used. It was statistically compared with the 95% confidence interval using the Pearson coefficient, and p<0.05 was interpreted as significant. The values of the loading forces applied to the samples in the groups were subjected to analysis of variance (ANOVA) to confirm the normality of the sample. Multiple comparisons were made between groups using the Tukey test. The mean loadings in the groups were analyzed by one-way ANOVA. CONCLUSION In general, as the strength of the force increases, the displacement values increase in all groups, but although it was observed that the locked miniplate/screw system was more stable than the standard miniplate/screw system, no statistically significant difference was found.
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Affiliation(s)
- Lütfiye Yazar
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
| | - Barış Altuğ Aydil
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
| | - Mustafa Ayhan
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
| | - Yağmur Çömlekçioğlu
- Department of Oral and Maxillfacial Surgery, Istanbul University Faculty of Dentistry, İstanbul-Turkey
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Ma HD, Shu JH, Deng XZ, Liu Z. Effect of sagittal split ramus osteotomy on morphologic parameters of temporomandibular joint in patients with mandibular prognathism. Medicine (Baltimore) 2019; 98:e15830. [PMID: 31145325 PMCID: PMC6708877 DOI: 10.1097/md.0000000000015830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to evaluate the change in three-dimensional morphology and clinical symptoms of temporomandibular joint (TMJ) in class III dentofacial deformity patients postoperatively for 6 months after sagittal split ramus osteotomy (SSRO).Seventeen patients with skeletal Class III malocclusion and 10 asymptomatic volunteers (classified as Control group) were recruited for the study and underwent cone-beam computed tomography scanning. The geometries of the maxilla and mandible were reconstructed using MIMICS (Materialise, Leuven, Belgium). The morphologic measurements of the patients' TMJs were done before surgery and at 6-month follow-up - named as Pre and Post groups, respectively.The joint spaces (medial joint space, superior joint space, lateral joint space, anterior joint space, and posterior joint space) of the Control group were significantly greater than those of the Pre and Post groups (P < .05), and SSRO did not significantly change the TMJ morphology parameters. Five patients were found to have preoperative temporomandibular disorder (TMD) symptoms, and 3 of them were relieved at 6 months after surgery. Postoperative TMD symptom was observed in 1 patient without preoperative TMD symptom.SSRO did not markedly alter the TMJ morphology of the patients with mandibular prognathism. The effects of SSRO on TMD symptoms should be related to the type of deformity.
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Shu JH, Yao J, Zhang YL, Chong DY, Liu Z. The influence of bilateral sagittal split ramus osteotomy on the stress distributions in the temporomandibular joints of the patients with facial asymmetry under symmetric occlusions. Medicine (Baltimore) 2018; 97:e11204. [PMID: 29924045 PMCID: PMC6023726 DOI: 10.1097/md.0000000000011204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints (TMJs) of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy (BSSRO) under the symmetric occlusions using the three-dimensional (3D) finite element method.Ten facial asymmetry patients (Preoperative group, age 24.6 ± 4.8 years) and 10 asymptomatic subjects (Control group, age 26.8 ± 4.9 years) were recruited. After the patients underwent BSSRO, they were further assigned as the Postoperative group. 3D geometries of the finite element models of the mandible, disc, maxilla, and teeth were reconstructed according to cone-beam computed tomography (CBCT) image data. Contact elements were used to simulate the interaction of the disc-condyle, disc-temporal bone, and upper-lower dentition. The muscle forces and boundary conditions corresponding to the central and anterior occlusions were applied on the models of the 3 groups. The finite element models were validated with experimental data showing the accuracy of the simulation results.The simulation predicted preoperative significant differences of stresses between non-deviated sides and deviated sides were disappeared after the surgery under the central and anterior occlusions (P < .05). Almost all stresses in the patient models had significantly decreased after BSSRO, leveling it to the stress values of the normal subjects. Moreover, the simulation results coincided with the clinical cases which showed that BSSRO had helped to release or remove the signs and symptoms of temporomandibular disorders (TMD).In conclusion, BSSRO could correct the asymmetric stress distributions of TMJs and decrease the magnitude of the stresses for the patients with facial asymmetry. Those decreases also associated with the recovery of TMD.
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Affiliation(s)
- Jing-Heng Shu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu
| | - Jie Yao
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yuan-Li Zhang
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu
| | - Desmond Y.R. Chong
- Engineering Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu
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Minami‐Sugaya H, Lentini‐Oliveira DA, Carvalho FR, Machado MAC, Marzola C, Saconato H, Prado GF. WITHDRAWN: Treatments for adults with prominent lower front teeth. Cochrane Database Syst Rev 2018; 5:CD006963. [PMID: 29791019 PMCID: PMC6494428 DOI: 10.1002/14651858.cd006963.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prominent lower front teeth may be associated with a large or prognathic lower jaw (mandible) or a small or retrusive upper jaw (maxilla). Edward Angle, who may be considered the father of modern orthodontics, classified the malocclusion in this situation as Class III. The individual is described as having a negative or reverse overjet as the lower front teeth are more prominent than the upper front teeth. OBJECTIVES The purpose of this systematic review was to evaluate different treatments of Angle Class III malocclusion in adults. SEARCH METHODS The following databases were searched: Cochrane Oral Health Group Trials Register (to 22 March 2012); CENTRAL (The Cochrane Library 2012, Issue 1); MEDLINE via OVID (1950 to 22 March 2012); EMBASE via OVID (1980 to 22 March 2012); LILACs (1982 to 22 March 2012); BBO (1986 to 22 March 2012); and SciELO (1997 to 22 March 2012). SELECTION CRITERIA All randomized or quasi-randomized controlled trials of treatments for adults with an Angle Class III malocclusion were included. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the eligibility of the identified reports. Two review authors independently extracted data and assessed the risk of bias in the included studies. The mean differences with 95% confidence intervals were calculated for continuous data. MAIN RESULTS Two randomized controlled trials were included in this review. There are different types of surgery for this type of malocclusion but only trials of mandible reduction surgery were identified. One trial compared intraoral vertical ramus osteotomy (IVRO) with sagittal split ramus osteotomy (SSRO) and the other trial compared vertical ramus osteotomy (VRO) with and without osteosynthesis. Neither trial found any difference between the two treatments. The trials did not provide adequate data for assessing effectiveness of the techniques described. AUTHORS' CONCLUSIONS There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required.
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Affiliation(s)
- Hideko Minami‐Sugaya
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Débora A Lentini‐Oliveira
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Fernando R Carvalho
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Marco Antonio C Machado
- Universidade Federal de São PauloNeuro‐Sono Sleep Center, Department of NeurologyRua Americo Salvador Novelli, 508ItaqueraSão PauloSão PauloBrazil08210‐090
| | - Clóvis Marzola
- Faculty of Odontology of Bauru, University of São PauloDepartment of SurgeryPedroso Alvarenga 772/71São PauloItaim BibiBrazil04531‐002
| | - Humberto Saconato
- Santa Casa de Campo MourãoDepartment of MedicineBR 158 Saída para Peabiru, 2761Campo MourãoCampo MourãoBrazil87309‐650
| | - Gilmar F Prado
- Escola Paulista de Medicina, Universidade Federal de São PauloDepartment of NeurologySão PauloSão PauloBrazil
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Lim SY, Jiang T, Oh MH, Kook MS, Cho JH, Hwang HS. Cone-beam computed tomography evaluation on the changes in condylar long axis according to asymmetric setback in sagittal split ramus osteotomy patients. Angle Orthod 2018; 87:254-259. [PMID: 28253453 DOI: 10.2319/043016-349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine whether the condylar rotation is affected by asymmetric setback in patients undergoing sagittal split ramus osteotomy. MATERIALS AND METHODS Thirty patients who underwent bilateral sagittal split ramus osteotomy setback surgery were divided into the two groups, symmetric setback and asymmetric setback, according to the right/left difference of setback amount (<2.0, ≥2.0 mm). Condylar long axis changes were evaluated using the three-dimensional superimposition of before and immediately after surgery cone-beam computed tomography volume images. Evaluations were performed separately in lesser setback and greater setback side in patients undergoing asymmetric setback, whereas both side condyles were evaluated together in patients undergoing symmetric setback. Condylar axis changes on axial view were correlated with setback amount or right/left setback difference using Pearson correlation analysis. RESULTS In general, the condylar axis change occurred in a pattern of inward rotation. The condyles in patients undergoing symmetric setback showed 3.4° rotation in average. In case of asymmetric setback, the lesser setback side showed larger value (4.3°) than the greater setback side (2.3°) with a statistical significance. In the correlation analysis, setback amount showed no significant correlation with the condylar axis changes in both groups. However, correlation with right/left setback difference showed a positive correlation in lesser setback side of patients undergoing asymmetric setback. CONCLUSION The findings of this study indicate that large amount of setback alone does not contribute to the change in condylar long axis, but asymmetric setback might cause a change in condylar long axis, particularly on the lesser setback side.
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Knepil GJ. Patients should now be informed of the benefits of the use of a piezoelectric saw before orthognathic bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2017; 56:157-158. [PMID: 29279236 DOI: 10.1016/j.bjoms.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- G J Knepil
- Gloucester Hospitals NHS Foundation Trust, Department of Oral and Maxillofacial Surgery, Gloucester Royal Hospital, Great Western Rd, Gloucester GL1 3NN; Bristol University.
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Yeo BR, Han JJ, Jung S, Park HJ, Oh HK, Kook MS. Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography data. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:14-19. [PMID: 28958899 DOI: 10.1016/j.oooo.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/20/2017] [Accepted: 07/14/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3-dimensional computed tomography (3-D CT). STUDY DESIGN This study included 66 patients who underwent bilateral sagittal split ramus osteotomy for correction of mandibular prognathism. With the use of 3-D CT data obtained preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3), horizontal changes of the proximal mandibular segment, including the intercondylar width, the intergonial width, and the frontal-ramal inclination were evaluated. RESULTS The value of the right frontal-ramal inclination was 11.43 ± 1.36° at T1, 11.91 ± 1.96° at T2, and 10.7 ± 1.5° at T3. The values of the left frontal-ramal inclination were 6.10 ± 1.03° at T1, 8.17 ± 1.66° at T2, and 7.66 ± 1.65° at T3. The values of the intergonial width were 99.67 ± 1.67 mm at T1, 98.24 ± 1.72 mm at T2, and 97.08 ± 1.71 mm at T3. The intergonial width was significantly decreased at T3 compared with T1 (P < .001). The values of the intercondylar width were 123.51 ± 1.66 mm at T1, 123.9 ± 1.66 mm at T2, and 122.88 ± 1.58 mm at T3. CONCLUSIONS Lower facial width at mandibular angle region decreased immediately after mandibular setback surgery and showed further decreases during the postoperative period.
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Affiliation(s)
- Bo-Ram Yeo
- 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
| | - Seunggon Jung
- 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
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea.
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Ueki K, Yoshizawa K, Moroi A, Iguchi R, Kosaka A, Ikawa H, Hotta A, Tsutsui T, Saito Y, Fukaya K, Hiraide R, Takayama A, Tsunoda T. Condylar surface CT value in sagittal plane before and after sagittal split ramus osteotomy. Oral Maxillofac Surg 2017; 21:159-169. [PMID: 28247093 DOI: 10.1007/s10006-017-0612-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/20/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between computed tomography (CT) values of the condylar surface and temporomandibular joint (TMJ) disc position in the sagittal plane before and after sagittal split ramus osteotomy (SSRO) setback surgery, retrospectively. MATERIALS AND METHODS The subjects were 75 patients (150 condyles) who underwent bilateral SSRO setback surgery. They were divided into two groups (42 symmetric patients and 33 asymmetric patients). Maximum CT values (pixel values) of five points of the condylar surface and condylar height, length, fossa height, fossa length, and ramus angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement, anterior type, fully covered type, and posterior type, both pre- and postoperatively, using magnetic resonance imaging (MRI). RESULTS Postoperative value was significantly higher than preoperative one in CT value of 135° (P = 0.0199) and 180° (0.0363), in the non-deviation side in the asymmetry group. The anterior disc displacement group was significantly larger than those of some other areas pre- and postoperatively in the CT value of 0° point (P < 0.05). CONCLUSIONS This study suggested that CT value of the posterior site of the condylar surface could change in the non-deviation side in the asymmetry group after 1 year SSRO, and the condyle with anterior displacement showed high CT value at the anterior site of the condyle before and after surgery.
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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
| | - Akinori Moroi
- 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
| | - Akihiko Kosaka
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato Chuo, Yamanashi, 409-3893, Japan
| | - Hiroumi Ikawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato Chuo, Yamanashi, 409-3893, Japan
| | - Asami Hotta
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato Chuo, Yamanashi, 409-3893, Japan
| | - Takamitsu Tsutsui
- 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
| | - Kenichi Fukaya
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato Chuo, Yamanashi, 409-3893, Japan
| | - Ryota Hiraide
- 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
| | - Tatsuya Tsunoda
- 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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Oh MH, Hwang HS, Lee KM, Cho JH. Cone-beam computed tomography evaluation on the condylar displacement following sagittal split ramus osteotomy in asymmetric setback patients: Comparison between conventional approach and surgery-first approach. Angle Orthod 2017; 87:733-738. [PMID: 28530843 DOI: 10.2319/122316-925.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the condylar displacement following sagittal split ramus osteotomy (SSRO) in asymmetric setback patients between the conventional approach and surgery-first approach and to determine whether the condylar displacement is affected by asymmetric setback in SSRO patients. MATERIALS AND METHODS This was a retrospective study. The subjects consisted of patients with facial asymmetry who underwent SSRO and had cone-beam computed tomography taken before and 1 month after surgery. They were allocated into the conventional (n = 18) and surgery-first (SF) groups (n = 20). Descriptive, independent t-tests and Pearson correlation analysis were computed. RESULTS The amount of condylar displacement in x-, y-, and z-directions and Euclidean distance showed no statistically significant differences between the conventional and SF groups. Comparing the postoperative condylar position with the preoperative position, the condylar displacement occurred in posterior (P < .05) and downward (P < .05) directions in both groups except on the deviated side in the conventional group. The condylar displacement occurred in a posterior (P < .05) direction on the deviated side of the conventional group. However, the condylar displacement in three dimensions showed no statistically significant differences between the two groups. In the correlation analysis, the condylar displacement in both the deviated and contralateral sides showed no significant correlation with asymmetric setback in either group. CONCLUSION The condylar displacement in three dimensions and the distance of condylar displacement in SSRO patients with facial asymmetry showed no significant difference between conventional and SF groups. Condylar displacement was not associated with asymmetric setback.
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Grimaud F, Bertin H, Fauvel F, Corre P, Perrin JP. Vertical ramus elongation and mandibular advancement by endobuccal approach: Presentation of a new osteotomy technique. J Stomatol Oral Maxillofac Surg 2017; 118:66-69. [PMID: 28330579 DOI: 10.1016/j.jormas.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/10/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Several surgical procedures have been proposed for the treatment of hyperdivergent dentoskeletal deformities. We propose a new osteotomy technique allowing for lengthening and advancement of the mandibular ramus by intra-oral approach. SURGICAL PROCEDURE This technique differs from the conventional sagittal split osteotomyin that which the anterior osteotomy line is not continued until the basilar edge but stopped 5-6mm above it. Cutting of the pterygomasseteric sling is systematically done allowing for the lowering of the mandibular angle. Osteosynthesis is performed by transjugal and intra-oral approaches, using two adjustable miniplates. Our supra-angular technique allows for both elongation of the ramus and advancement of the mandible. Unlike the vertical ramus osteotomy proposed by Caldwell-Letterman, external incision and intraoperative cervical hyperextension are not required.
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Affiliation(s)
- F Grimaud
- Department of stomatology and maxillofacial surgery, university hospital center of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - H Bertin
- Department of stomatology and maxillofacial surgery, university hospital center of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Fauvel
- Department of stomatology and maxillofacial surgery, university hospital center of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - P Corre
- Department of stomatology and maxillofacial surgery, university hospital center of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J-P Perrin
- Department of stomatology and maxillofacial surgery, university hospital center of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Tyan S, Kim HH, Park KH, Kim SJ, Kim KA, Ahn HW. Sequential changes of postoperative condylar position in patients with facial asymmetry. Angle Orthod 2016; 87:260-268. [PMID: 27529733 DOI: 10.2319/030916-203.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate sequential images of the condylar position in relation to the glenoid fossa after orthognathic surgery in patients with facial asymmetry using cone beam computed tomography. MATERIALS AND METHODS A total of 20 adult patients (11 men and 9 women; mean age, 22.1 ± 4.02 years) with facial asymmetry who underwent sagittal split ramus osteotomy with rigid fixation were involved. Cone beam computed tomography scans were obtained before treatment (T0), 1 month before the surgery (T1), and 1 day (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after the surgery. The condyle position was evaluated. RESULTS At 1 day after surgery (T2), the condylar position on both sides significantly changed posteriorly, inferiorly, and laterally, but no significant difference was observed between the nonaffected and affected sides. The condyle on the nonaffected side had a tendency to recover its preoperative position at 3 months after surgery (T3) and inclined slightly laterally up to 1 year after the surgery (T5). The condyle on the affected side returned more closely to the glenoid fossa than to its pretreatment position at 3 months after surgery (T3). Thereafter, it showed a more backward and downward position (T5). CONCLUSIONS The overall condylar position after an orthognathic surgery in patients with facial asymmetry was relatively stable at 1 year after surgery. However, the condyle on the affected side during the first 3 months after surgery should be carefully monitored for surgical stability.
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Ding Y, Yang B, Ni J, Li B, Cao Y. [Sagittal split ramus osteotomy combined with intraoral distraction osteogenesis for hemifacial microsomia]. Zhonghua Zheng Xing Wai Ke Za Zhi 2016; 32:161-165. [PMID: 30043598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of sagittal split ramus osteotomy(SSRO) combined with distraction osteogenesis(DO) for hemifacial microsomia (HFM). METHODS From January 2013 to September 2015,7 cases of unilateral HFM were included in the study. The 3-dimensional reconstruction images were used for the operation design. The location of the germs and inferior alveolar nerve was marked to avoid injury. The distractor was fixed after SSRO. The distractor was distracted 2-4 mm intraoperatively and began enlongation 3-5 days after operation,1-2 mm every day until the pre-designed length attained. The patients were followed up for 3-D CT and measurement of the height of bilateral ramus. RESULTS The enlongation length was 7 mm to 20 mm(mean,14.6 mm).The facial symmetry and occlusion plane was improved a lot. No complication occurred. The mean follow-up period was 22 months (range 17-32 months) with almost symmetrical appearance and occlusion function. CONCLUSIONS SSRO combined with DO has a good therapeutic effect and low complication for patients with HFM. The distraction rate is relatively high with a short treatment period. The ramus width, even thickness, are not decreased, or even can be increased after DO.
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Tabrizi R, Pakshir H, Behnia H, Akhlaghi S, Shahsavari N. Does mandibular osteotomy affect gonial angle in patients with class III deformity? Vertical ramus osteotomy versus sagittal split osteotomy. Int J Oral Maxillofac Surg 2016; 45:992-6. [PMID: 27012604 DOI: 10.1016/j.ijom.2016.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/18/2015] [Accepted: 02/25/2016] [Indexed: 11/18/2022]
Abstract
The mandibular angle represents an important part of facial aesthetics. Mandibular osteotomy can affect the gonial angle. The aim of this study was to compare the effects of sagittal split osteotomy (SSO) and intraoral vertical ramus osteotomy (IVRO) on the gonial angle. This retrospective cohort study assessed subjects with mandibular prognathism who underwent SSO (group 1) or IVRO (group 2). Lateral cephalograms obtained before and 1 year after the osteotomies were analyzed. In this study, age, sex, the change in occlusal plane (OP) and mandibular plane (MP) angles, and the amount of mandibular setback were considered as variable factors, while the type of surgery (SSO or IVRO) was considered the predictive factor. Fifty-six subjects were studied: 26 in group 1 and 30 in group 2. The changes in MP angle and OP angle were not significantly different between the groups (P>0.05). The change in gonial angle was 6.07±4.46° in group 1 and 7.33±5.73° in group 2; assessment of the data did not demonstrate a significant difference between the two groups studied (P=0.53). Mandibular osteotomy (SSO or IVRO) may change the gonial angle, but a significant difference between SSO and IVRO was not detected.
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Affiliation(s)
- R Tabrizi
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - H Pakshir
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Behnia
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Akhlaghi
- International Branch, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Shahsavari
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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