Postsurgical Stability of Temporomandibular Joint of Skeletal Class III Patients Treated with 2-Jaw Orthognathic Surgery Via Computer-Aided Three-Dimensional Simulation and Navigation in Orthognathic Surgery (CASNOS)

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2021 Aug 19

PMID 34409098

Citations 6

Authors

Ling-Chun Wang

Yi-Hao Lee

Chi-Yu Tsai

Te-Ju Wu

Ya-Ying Teng

Jui-Pin Lai

Shiu-Shiung Lin

Yu-Jen Chang

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study is to clarify the postsurgical stability of temporomandibular joints in skeletal class III patients treated with 2-jaw orthognathic surgery which was performed utilizing computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS) protocol.

Materials And Methods: 23 consecutive nongrowing skeletal class III patients with mandibular prognathism associated with maxillary retrognathism treated with 2-jaw orthognathic surgery between 2018 and 2019 were enrolled in this study. The surgery was planned according to the standardized protocol of CASNOS (computer-aided three-dimensional simulation and navigation in orthognathic surgery). Computed tomography (CT) scans were performed in all patients 3 weeks presurgically and 6 months postsurgically. ITKSNAP and 3D Slicer software were used to reconstruct three-dimensional facial skeletal images, to carry out image segmentation, and to superimpose and quantify the TMJ position changes before and after surgery. Amount of displacement of the most medial and lateral points of the condyles and the change of intercondylar angles were measured to evaluate the postsurgical stability of TMJ.

Results: A total amount of 23 skeletal class III patients (female : male = 12 : 11) with age ranged from 20.3 to 33.5 years (mean: 24.39 ± 4.8 years old) underwent Le Fort I maxillary advancement and BSSO setback of the mandible. The surgical outcome revealed the satisfactory correction of their skeletal deformities. The mean displacement of the right most lateral condylar point (RL-RL') was 1.04 ± 0.42 mm and the mean displacement of the left most lateral condylar point (LL-LL') was 1.19 ± 0.41 mm. The mean displacement of the right most medial condylar point (RM-RM') was 1.03 ± 0.39 mm and the left most medial condylar point (LM-LM') was 0.96 ± 0.39 mm. The mean intercondylar angle was 161.61 ± 5.08° presurgically and 159.28 ± 4.92° postsurgically.

Conclusion: The postsurgical position of TM joint condyles in our study only presented a mild change with all the landmark displacement within a range of 1.2 mm. This indicates the bimaxillary orthognathic surgery via 3D CASNOS protocol can achieve a desired and stable result of TMJ position in treating skeletal class III adult patients with retrognathic maxilla and prognathic mandible.

Citing Articles

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Three-Dimensional Mandibular Condyle Remodeling Post-Orthognathic Surgery: A Systematic Review.

Petronis Z, Janovskiene A, Rokicki J, Razukevicius D Medicina (Kaunas). 2024; 60(10).

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Direction and Range of Condylar Positional Changes in the First-Year Post-surgical Orthodontics Interventions in Adult Patients with Skeletal Class III Deformity: A Systematic Review and Meta-analysis.

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Comparison of the Post-Surgical Position of the Temporomandibular Joint after Orthognathic Surgery in Skeletal Class III Patients and Patients with Cleft Lip and Palate.

Lee Y, Tsai C, Wang L, Lai U, Lai J, Lin S J Pers Med. 2022; 12(9).

PMID: 36143222 PMC: 9506436. DOI: 10.3390/jpm12091437.

References

HARRIS M, Van Sickels J, Alder M . Factors influencing condylar position after the bilateral sagittal split osteotomy fixed with bicortical screws. J Oral Maxillofac Surg. 1999; 57(6):650-4; discussion 654-5. DOI: 10.1016/s0278-2391(99)90422-6. View

An S, Park S, Kim Y, Son W . Effect of post-orthognathic surgery condylar axis changes on condylar morphology as determined by 3-dimensional surface reconstruction. Angle Orthod. 2013; 84(2):316-21. PMC: 8673793. DOI: 10.2319/052113-387.1. View

Tseng Y, Pan C, Chou S, Liao C, Lai S, Chen C . Treatment of adult Class III malocclusions with orthodontic therapy or orthognathic surgery: receiver operating characteristic analysis. Am J Orthod Dentofacial Orthop. 2011; 139(5):e485-93. DOI: 10.1016/j.ajodo.2010.12.014. View

Hoppenreijs T, Freihofer H, Stoelinga P, Tuinzing D, vant Hof M . Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite. A clinical and radiological study. Int J Oral Maxillofac Surg. 1998; 27(2):81-91. DOI: 10.1016/s0901-5027(98)80301-9. View

Ellis 3rd E, Hinton R . Histologic examination of the temporomandibular joint after mandibular advancement with and without rigid fixation: an experimental investigation in adult Macaca mulatta. J Oral Maxillofac Surg. 1991; 49(12):1316-27. DOI: 10.1016/0278-2391(91)90311-9. View

Hu J, Wang D, Zou S . Effects of mandibular setback on the temporomandibular joint: a comparison of oblique and sagittal split ramus osteotomy. J Oral Maxillofac Surg. 2000; 58(4):375-80; discussion 380-1. DOI: 10.1016/s0278-2391(00)90915-7. View

Holzinger D, Willinger K, Millesi G, Schicho K, Breuss E, Wagner F . Changes of temporomandibular joint position after surgery first orthognathic treatment concept. Sci Rep. 2019; 9(1):2206. PMC: 6379562. DOI: 10.1038/s41598-019-38786-2. View

Costa F, Robiony M, Toro C, Sembronio S, Polini F, Politi M . Condylar positioning devices for orthognathic surgery: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106(2):179-90. DOI: 10.1016/j.tripleo.2007.11.027. View

Ha M, Kim Y, Park S, Kim S, Son W . Cone-beam computed tomographic evaluation of the condylar remodeling occurring after mandibular set-back by bilateral sagittal split ramus osteotomy and rigid fixation. Korean J Orthod. 2014; 43(6):263-70. PMC: 3879282. DOI: 10.4041/kjod.2013.43.6.263. View

10.

Carlos de Oliveira Ruellas A, Tonello C, Gomes L, Yatabe M, Macron L, Lopinto J . Common 3-dimensional coordinate system for assessment of directional changes. Am J Orthod Dentofacial Orthop. 2016; 149(5):645-56. PMC: 4959834. DOI: 10.1016/j.ajodo.2015.10.021. View

11.

Ueki K, Marukawa K, Shimada M, Nakagawa K, Yamamoto E . Change in condylar long axis and skeletal stability following sagittal split ramus osteotomy and intraoral vertical ramus osteotomy for mandibular prognathia. J Oral Maxillofac Surg. 2005; 63(10):1494-9. DOI: 10.1016/j.joms.2005.06.013. View

12.

Chen S, Lei J, Wang X, Fu K, Farzad P, Yi B . Short- and long-term changes of condylar position after bilateral sagittal split ramus osteotomy for mandibular advancement in combination with Le Fort I osteotomy evaluated by cone-beam computed tomography. J Oral Maxillofac Surg. 2013; 71(11):1956-66. DOI: 10.1016/j.joms.2013.06.213. View

13.

Vandeput A, Verhelst P, Jacobs R, Shaheen E, Swennen G, Politis C . Condylar changes after orthognathic surgery for class III dentofacial deformity: a systematic review. Int J Oral Maxillofac Surg. 2018; 48(2):193-202. DOI: 10.1016/j.ijom.2018.06.008. View

14.

Sander A, Martini M, Konermann A, Meyer U, Wenghoefer M . Freehand Condyle-Positioning During Orthognathic Surgery: Postoperative Cone-Beam Computed Tomography Shows Only Minor Morphometric Alterations of the Temporomandibular Joint Position. J Craniofac Surg. 2015; 26(5):1471-6. DOI: 10.1097/SCS.0000000000001781. View

15.

Chang Y, Ruellas A, Yatabe M, Westgate P, Cevidanes L, Huja S . Soft Tissue Changes Measured With Three-Dimensional Software Provides New Insights for Surgical Predictions. J Oral Maxillofac Surg. 2017; 75(10):2191-2201. PMC: 5698014. DOI: 10.1016/j.joms.2017.05.010. View

16.

Kim Y, Jung Y, Cho B, Kim J, Kim S, Son W . The assessment of the short- and long-term changes in the condylar position following sagittal split ramus osteotomy (SSRO) with rigid fixation. J Oral Rehabil. 2010; 37(4):262-70. DOI: 10.1111/j.1365-2842.2009.02056.x. View

17.

Chang Y, Lai J, Tsai C, Wu T, Lin S . Accuracy assessment of computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS). J Formos Med Assoc. 2019; 119(3):701-711. DOI: 10.1016/j.jfma.2019.09.017. View

18.

Arnett G, Milam S, GOTTESMAN L . Progressive mandibular retrusion--idiopathic condylar resorption. Part I. Am J Orthod Dentofacial Orthop. 1996; 110(1):8-15. DOI: 10.1016/s0889-5406(96)70081-1. View

19.

Frey D, Hatch J, Van Sickels J, Dolce C, Rugh J . Effects of surgical mandibular advancement and rotation on signs and symptoms of temporomandibular disorder: a 2-year follow-up study. Am J Orthod Dentofacial Orthop. 2008; 133(4):490.e1-8. DOI: 10.1016/j.ajodo.2007.10.033. View

20.

Katsumata A, Nojiri M, Fujishita M, Ariji Y, Ariji E, Langlais R . Condylar head remodeling following mandibular setback osteotomy for prognathism: a comparative study of different imaging modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101(4):505-14. DOI: 10.1016/j.tripleo.2005.07.028. View