Positional Changes of the Mandibular Condyle in Unilateral Sagittal Split Ramus Osteotomy Combined with Intraoral Vertical Ramus Osteotomy for Asymmetric Class III Malocclusion

Overview

Journal J Korean Assoc Oral Maxillofac Surg

Date 2021 Oct 29

PMID 34713812

Citations 2

Authors

Jun Park

Ki-Eun Hong

Ji-Eon Yun

Eun-Sup Shin

Chul-Hoon Kim

Bok-Joo Kim

Jung-Han Kim

Affiliations

Soon will be listed here.

Abstract

Objectives: In the present study, the effects of sagittal split ramus osteotomy (SSRO) combined with intraoral vertical ramus osteotomy (IVRO) for the treatment of asymmetric mandible in class Ⅲ malocclusion patients were assessed and the postoperative stability of the mandibular condyle and the symptoms of temporomandibular joint disorder (TMD) evaluated.

Materials And Methods: A total of 82 patients who underwent orthognathic surgery for the treatment of facial asymmetry or mandibular asymmetry at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital, from 2016 to 2021 were selected. The patients that underwent SSRO with IVRO were assigned to Group I (n=8) and patients that received bilateral SSRO (BSSRO) to Group II (n=10, simple random sampling). Preoperative and postoperative three-dimensional computed tomography (CT) axial images obtained for each group were superimposed. The condylar position changes and degree of rotation on the superimposed images were measured, and the changes in condyle based on the amount of chin movement for each surgical method were statistically analyzed.

Results: Group I showed a greater amount of postoperative chin movement. For the amount of mediolateral condylar displacement on the deviated side, Groups I and II showed an average lateral displacement of 0.07 mm and 1.62 mm, respectively, and statistically significantly correlated with the amount of chin movement (=0.004). Most of the TMD symptoms in Group I patients who underwent SSRO with IVRO showed improvement.

Conclusion: When a large amount of mandibular rotation is required to match the menton to the midline of the face, IVRO on the deviated side is considered a technique to prevent condylar torque. In the present study, worsening of TMD symptoms did not occur after orthognathic surgery in any of the 18 patients.

Citing Articles

Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis.

Kim Y, Kim M, Jha N, Jung M, Kwon Y, Shin H Korean J Orthod. 2024; 54(2):89-107.

PMID: 38533597 PMC: 10973727. DOI: 10.4041/kjod23.194.

Evaluation of the Mandibular Condyle Morphologic Relation before and after Orthognathic Surgery in Class II and III Malocclusion Patients Using Cone Beam Computed Tomography.

Roman R, Almasan O, Hedesiu M, Baciut M, Bran S, Popa D Biology (Basel). 2022; 11(9).

PMID: 36138832 PMC: 9495726. DOI: 10.3390/biology11091353.

References

Watzke I, Heinrich A . The impact of bilateral sagittal split osteotomy on mandibular width and morphology. J Oral Maxillofac Surg. 2002; 60(5):502-4; discussion 505. DOI: 10.1053/joms.2002.31845. View

Onizawa K, Schmelzeisen R, Vogt S . Alteration of temporomandibular joint symptoms after orthognathic surgery: comparison with healthy volunteers. J Oral Maxillofac Surg. 1995; 53(2):117-21; discussion 122-3. DOI: 10.1016/0278-2391(95)90383-6. View

TRAUNER R, OBWEGESER H . The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 1957; 10(9):899-909. DOI: 10.1016/s0030-4220(57)80041-3. View

Kang M, Yun K, Kim C, Park J . Postoperative condylar position by sagittal split ramus osteotomy with and without bone graft. J Oral Maxillofac Surg. 2010; 68(9):2058-64. DOI: 10.1016/j.joms.2009.12.015. View

Ueki K, Degerliyurt K, Hashiba Y, Marukawa K, Nakagawa K, Yamamoto E . Horizontal changes in the condylar head after sagittal split ramus osteotomy with bent plate fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106(5):656-61. DOI: 10.1016/j.tripleo.2008.03.016. View

Rotskoff K, Herbosa E, Nickels B . Correction of condylar displacement following intraoral vertical ramus osteotomy. J Oral Maxillofac Surg. 1991; 49(4):366-72; discussion 373-4. DOI: 10.1016/0278-2391(91)90372-s. View

Hwang S, Haers P, Zimmermann A, Oechslin C, Seifert B, Sailer H . Surgical risk factors for condylar resorption after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89(5):542-52. DOI: 10.1067/moe.2000.105239. View

Yang H, Hwang S . Change in condylar position in posterior bending osteotomy minimizing condylar torque in BSSRO for facial asymmetry. J Craniomaxillofac Surg. 2013; 42(4):325-32. DOI: 10.1016/j.jcms.2013.05.021. View

Ghali G, Sikes Jr J . Intraoral vertical ramus osteotomy as the preferred treatment for mandibular prognathism. J Oral Maxillofac Surg. 2000; 58(3):313-5. DOI: 10.1016/s0278-2391(00)90063-6. View

10.

Spiessl B . [Osteosynthesis in sagittal osteotomy using the Obwegeser-Dal Pont method]. Fortschr Kiefer Gesichtschir. 1974; 18:145-8. View

11.

Dujoncquoy J, Ferri J, Raoul G, Kleinheinz J . Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study. Head Face Med. 2010; 6:27. PMC: 2998459. DOI: 10.1186/1746-160X-6-27. View

12.

Jung H, Kim S, Park H, Jung Y . Orthognathic surgery and temporomandibular joint symptoms. Maxillofac Plast Reconstr Surg. 2015; 37(1):14. PMC: 4446569. DOI: 10.1186/s40902-015-0014-4. View

13.

Panula K, Finne K, Oikarinen K . Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg. 2001; 59(10):1128-36; discussion 1137. DOI: 10.1053/joms.2001.26704. View

14.

Ellis 3rd E . A method to passively align the sagittal ramus osteotomy segments. J Oral Maxillofac Surg. 2007; 65(10):2125-30. DOI: 10.1016/j.joms.2007.02.005. View

15.

Al-Moraissi E, Wolford L, Perez D, Laskin D, Ellis 3rd E . Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017; 75(9):1835-1847. DOI: 10.1016/j.joms.2017.03.029. View

16.

Wolford L, Reiche-Fischel O, Mehra P . Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac Surg. 2003; 61(6):655-60; discussion 661. DOI: 10.1053/joms.2003.50131. View

17.

Steinhauser E . Historical development of orthognathic surgery. J Craniomaxillofac Surg. 1996; 24(4):195-204. DOI: 10.1016/s1010-5182(96)80002-3. View

18.

Jung H, Jung Y, Park H . The chronologic prevalence of temporomandibular joint disorders associated with bilateral intraoral vertical ramus osteotomy. J Oral Maxillofac Surg. 2009; 67(4):797-803. DOI: 10.1016/j.joms.2008.11.003. View

19.

Naran S, Steinbacher D, Taylor J . Current Concepts in Orthognathic Surgery. Plast Reconstr Surg. 2018; 141(6):925e-936e. DOI: 10.1097/PRS.0000000000004438. View

20.

Lee J, Park T, Jeon J . Unilateral intraoral vertical ramus osteotomy and sagittal split ramus osteotomy for the treatment of asymmetric mandibles. J Korean Assoc Oral Maxillofac Surg. 2015; 41(2):102-8. PMC: 4411725. DOI: 10.5125/jkaoms.2015.41.2.102. View