Sınıf II ve Sınıf III Hastalarda Ortognatik Cerrahi Sonrası Kondil Değişiklikleri: Retrospektif Üç Boyutlu Çalışma
Abstract
Amaç: Ortognatik cerrahi (OGC) temporomandibular eklem (TME) bozukluklarına neden olabilir veya şiddetlendirebilir ve mandibular stabiliteyi etkileyebilir. Bu retrospektif çalışmanın amacı, Sınıf II ve Sınıf III maloklüzyonlu hastalarda OGC sonrası mandibular ve/veya maksiller ilerletme/geri alma ameliyatları sonucu mandibular kondil ve ramal açılarda meydana gelen değişiklikleri değerlendirmektir.
Gereç ve Yöntemler: OGC geçirmiş olan 25 iskeletsel Sınıf II (6 erkek ve 19 kadın ortalama yaş=26,28 ± 5,89 y) ve 25 iskeletsel Sınıf III (10 erkek ve 15 kadın ortalama yaş=23,32 ± 3,89 y) hastaya ait Konik Işınlı Bilgisayarlı Tomografi (KIBT) kayıtları seçildi. Ramus yüksekliği, uzunluğu, genişliği ve açısını ölçmek için KIBT görüntüleri ameliyattan önce (T0) ve ameliyattan 6 ay sonra (T1) ITK Snap yazılımı kullanılarak değerlendirildi. Kondil başındaki değişiklikler aksiyal, sagittal ve koronal kesitlerde ölçüldü. Gruplar arasındaki verilerin karşılaştırılmasında bağımsız t testi, grup içi korelasyonun değerlendirilmesinde Pearson korelasyon testi kullanıldı.
Bulgular: OGC sonrası aksiyel ramal açı hem Sınıf II (4,24°±4,68) hem de Sınıf III (1,52°±3,1) gruplarında anlamlı derecede azaldı (p<,05). Sagital düzlemdeki kondiler uzunluk her iki grupta da anlamlı derecede azaldı (p<,05) (Cl II= 0,68 mm, Cl III= 0,13 mm). Bu çalışma sonucunda OGC sonrasında kondil uzunluğunda rezorpsiyon meydana geldiği ve mandibular proksimal segmentin laterale rotasyon yaptığı tespit edildi.
Sonuçlar: OGC yapılması planlanan Sınıf II ve Sınıf III hastaların cerrahi öncesi ve sonrasında TME disfonksiyon açısından değerlendirilmesi uygun olacaktır.
References
- Hsu LF, Liu YJ, Kok SH, Chen YJ, et al. Differences of condylar changes after orthognathic surgery among Class II and Class III patients. J Formos Med Assoc. 2022;121:98-107.
- Catherine Z, Breton P, Bouletreau P. Condylar resorption after orthognathic surgery: A systematic review. Rev Stomatol Chir Maxillofac Chir Orale. 2016;117:3-10.
- Lo LJ, Weng JL, Ho CT, Lin HH. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. Plos One. 2018;13:e0200589.
- Oh KM, Seo SK, Park JE, Sim HS, et al. Post-operative soft tissue changes in patients with mandibular prognathism after bimaxillary surgery. J Cranio Maxill Surg. 2013;41:204-11.
- Kim NK, Lee C, Kang SH, Park JW, et al. A three-dimensional analysis of soft and hard tissue changes after a mandibular setback surgery. Comput Meth Prog Bio. 2006;83:178-87.
- Saccucci M, Polimeni A, Festa F, Tecco S. Do skeletal cephalometric characteristics correlate with condylar volume, surface and shape? A 3D analysis. Head Face Med. 2012;8:15.
- Joss CU, Vassalli IM. Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg. 2009;67:301-13.
- da Silva RJ, Souza CVV, Souza GA, Ambrosano GMB, et al. Changes in condylar volume and joint spaces after orthognathic surgery. Int J Oral Max Surg. 2018;47:511-7.
- Kim YJ, Oh KM, Hong JS, Lee JH, et al. Do Patients Treated With Bimaxillary Surgery Have More Stable Condylar Positions Than Those Who Have Undergone Single-Jaw Surgery? J Oral Maxil Surg. 2012;70:2143-52.
- An SB, Park SB, Kim YI, Son WS. Effect of post-orthognathic surgery condylar axis changes on condylar morphology as determined by 3-dimensional surface reconstruction. Angle Orthod. 2014;84:316-21.
- Kawamata A, Fujishita M, Nagahara K, Kanematu N, et al. Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy. Oral Surg Oral Med O. 1998;85:371-6.
- Park YW, Kang HS, Lee JH. Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly-L-lactide mesh versus titanium miniplate. Max Plast Reconstr S. 2019;41:8.
- Carvalho FDR, Cevidanes LHS, da Motta ATS, Almeida MAD, et al. Three-dimensional assessment of mandibular advancement 1 year after surgery. Am J Orthod Dentofac. 2010;4:137-S53–S55.
- Cevidanes LHS, Bailey LJ, Tucker GR, Styner MA, et al. Superimposition of 3D cone-beam CT models of orthognathic surgery patients. Dentomaxillofac Radiol. 2005;34:369-75.
- Verhelst PJ, Verstraete L, Shaheen E, Shujaat S, et al. Three-dimensional cone beam computed tomography analysis protocols for condylar remodelling following orthognathic surgery: a systematic review. Int J Oral Max Surg. 2020;49:207-17.
- Xi T, Schreurs R, van Loon B, de Koning M, et al. 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies. J Cranio Maxill Surg. 2015;43:462-8.
- Ferri J, Nicot R, Maes JM, Raoul G, Lauwers L. Condylar resorptions and orthodontic-surgical treatment: State of the art. Int Orthod. 2016;14:503-27.
- Kim YK, Yun PY, Ahn JY, Kim JW, Kim SG. Changes in the temporomandibular joint disc position after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:15-21.
- Bayram M, Kayipmaz S, Sezgin OS, Küçük M. Volumetric analysis of the mandibular condyle using cone beam computed tomography. Eur J Radiol. 2012;81:1812-6.
- Goulart DR, Muñoz P, López MGC, de Moraes M, Olate S. Comparative Evaluation of Condylar Volume Between Patients With Unilateral Condylar Hyperplasia and Class III Dentofacial Deformity. J Oral Maxil Surg. 2017;75:180-8.
- Schlueter B, Kim KB, Oliver D, Sortiropoulos G. Cone beam computed tomography 3D reconstruction of the mandibular condyle. Angle Orthod. 2008;78:880-8.
- Hylander WL. Experimental analysis of temporomandibular joint reaction force in macaques. Am J Phys Anthropol. 1979;51:433-56.
- Park SB, Yang YM, Kim YI, Cho BH, Jung YH, Hwang DS. Effect of bimaxillary surgery on adaptive condylar head remodeling: metric analysis and image interpretation using cone-beam computed tomography volume superimposition. J Oral Maxillofac Surg. 2012;70:1951-9.
- Ravelo V, Olate G, de Moraes M, Huentequeo C, Sacco R, Olate S. Condylar Positional Changes in Skeletal Class II and Class III Malocclusions after Bimaxillary Orthognathic Surgery. J. Pers. Med. 2023, 13, 1544.
- Paulsen HU, Karle A. Computer tomographic and radiographic changes in the temporomandibular joints of two young adults with occlusal asymmetry, treated with the Herbst appliance. Eur J Orthod. 2000;22:649-56.
- Méndez-Manjón I, Guijarro-Martínez R, Valls-Ontañón A, Hernández-Alfaro F. Early changes in condylar position after mandibular advancement: a three-dimensional analysis. Int J Oral Maxillofac Surg. 2016;45:787-92.
- Kim YI, Cho BH, Jung YH, Son WS, Park SB. Cone-beam computerized tomography evaluation of condylar changes and stability following two-jaw surgery: Le Fort I osteotomy and mandibular setback surgery with rigid fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:681-7.
- Panpitakkul P, Jorns TP, Kongsomboon S, Chaichit R, Sutthiprapaporn P. Three-Dimensional Changes of Condylar Position After Bimaxillary Surgery to Correct Skeletal III Malocclusion: Cone Beam Computed Tomography Voxel-Based Superimposition Analysis. J Oral Maxillofac Surg. 2024 Oct;82(10):1224-1238.
Changes in the Condyle After Orthognathic Surgery in Class II and Class III Patients: A Retrospective Three-Dimensional Study
Abstract
Aim: Orthognathic surgery (OGS) may cause or exacerbate temporomandibular joint (TMJ) disorders and affect mandibular stability. The aim of this retrospective study is to evaluate the changes in the mandibular condyle and ramal angles as a result of mandibular and/or maxiller advancement/set back surgeries in patients with Class ll and Class lll malocclusions after OGS.
Methods: Cone Beam Computed Tomography (CBCT) records which obtained 25 skeletal Class ll (6 males and 19 females mean ages=26.28 ± 5.89 y) and 25 skeletal Class lll (10 males and 15 females mean ages=23.32 ± 3.89 y) who had undergone OGS was selected. CBCT images were evaluated before surgery (T0) and 6 months after surgery (T1) using ITK Snap software to evaluate the measurement of the ramus. Changes of the condylar head were measured in axial, sagittal, and coronal sections.
Results: After OGS the axial ramal angle decreased significantly in both Class ll (4.24°±4.68) and Class III (1.52°±3.1) groups (p<.05). Condylar length in the sagittal dimension decreased significantly (p<.05) also in both groups (Cl II= 0.68 mm, Cl III= 0.13 mm). As a result of our study, it was found that resorption occurred in the condylar length and mandibular the proximal segment rotated laterally after OGS.
Conclusion: It would be appropriate to evaluate Class II and Class III patients who are planned to undergo OGS in terms of TMJ dysfunction before and after surgery.
References
- Hsu LF, Liu YJ, Kok SH, Chen YJ, et al. Differences of condylar changes after orthognathic surgery among Class II and Class III patients. J Formos Med Assoc. 2022;121:98-107.
- Catherine Z, Breton P, Bouletreau P. Condylar resorption after orthognathic surgery: A systematic review. Rev Stomatol Chir Maxillofac Chir Orale. 2016;117:3-10.
- Lo LJ, Weng JL, Ho CT, Lin HH. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. Plos One. 2018;13:e0200589.
- Oh KM, Seo SK, Park JE, Sim HS, et al. Post-operative soft tissue changes in patients with mandibular prognathism after bimaxillary surgery. J Cranio Maxill Surg. 2013;41:204-11.
- Kim NK, Lee C, Kang SH, Park JW, et al. A three-dimensional analysis of soft and hard tissue changes after a mandibular setback surgery. Comput Meth Prog Bio. 2006;83:178-87.
- Saccucci M, Polimeni A, Festa F, Tecco S. Do skeletal cephalometric characteristics correlate with condylar volume, surface and shape? A 3D analysis. Head Face Med. 2012;8:15.
- Joss CU, Vassalli IM. Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg. 2009;67:301-13.
- da Silva RJ, Souza CVV, Souza GA, Ambrosano GMB, et al. Changes in condylar volume and joint spaces after orthognathic surgery. Int J Oral Max Surg. 2018;47:511-7.
- Kim YJ, Oh KM, Hong JS, Lee JH, et al. Do Patients Treated With Bimaxillary Surgery Have More Stable Condylar Positions Than Those Who Have Undergone Single-Jaw Surgery? J Oral Maxil Surg. 2012;70:2143-52.
- An SB, Park SB, Kim YI, Son WS. Effect of post-orthognathic surgery condylar axis changes on condylar morphology as determined by 3-dimensional surface reconstruction. Angle Orthod. 2014;84:316-21.
- Kawamata A, Fujishita M, Nagahara K, Kanematu N, et al. Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy. Oral Surg Oral Med O. 1998;85:371-6.
- Park YW, Kang HS, Lee JH. Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly-L-lactide mesh versus titanium miniplate. Max Plast Reconstr S. 2019;41:8.
- Carvalho FDR, Cevidanes LHS, da Motta ATS, Almeida MAD, et al. Three-dimensional assessment of mandibular advancement 1 year after surgery. Am J Orthod Dentofac. 2010;4:137-S53–S55.
- Cevidanes LHS, Bailey LJ, Tucker GR, Styner MA, et al. Superimposition of 3D cone-beam CT models of orthognathic surgery patients. Dentomaxillofac Radiol. 2005;34:369-75.
- Verhelst PJ, Verstraete L, Shaheen E, Shujaat S, et al. Three-dimensional cone beam computed tomography analysis protocols for condylar remodelling following orthognathic surgery: a systematic review. Int J Oral Max Surg. 2020;49:207-17.
- Xi T, Schreurs R, van Loon B, de Koning M, et al. 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies. J Cranio Maxill Surg. 2015;43:462-8.
- Ferri J, Nicot R, Maes JM, Raoul G, Lauwers L. Condylar resorptions and orthodontic-surgical treatment: State of the art. Int Orthod. 2016;14:503-27.
- Kim YK, Yun PY, Ahn JY, Kim JW, Kim SG. Changes in the temporomandibular joint disc position after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:15-21.
- Bayram M, Kayipmaz S, Sezgin OS, Küçük M. Volumetric analysis of the mandibular condyle using cone beam computed tomography. Eur J Radiol. 2012;81:1812-6.
- Goulart DR, Muñoz P, López MGC, de Moraes M, Olate S. Comparative Evaluation of Condylar Volume Between Patients With Unilateral Condylar Hyperplasia and Class III Dentofacial Deformity. J Oral Maxil Surg. 2017;75:180-8.
- Schlueter B, Kim KB, Oliver D, Sortiropoulos G. Cone beam computed tomography 3D reconstruction of the mandibular condyle. Angle Orthod. 2008;78:880-8.
- Hylander WL. Experimental analysis of temporomandibular joint reaction force in macaques. Am J Phys Anthropol. 1979;51:433-56.
- Park SB, Yang YM, Kim YI, Cho BH, Jung YH, Hwang DS. Effect of bimaxillary surgery on adaptive condylar head remodeling: metric analysis and image interpretation using cone-beam computed tomography volume superimposition. J Oral Maxillofac Surg. 2012;70:1951-9.
- Ravelo V, Olate G, de Moraes M, Huentequeo C, Sacco R, Olate S. Condylar Positional Changes in Skeletal Class II and Class III Malocclusions after Bimaxillary Orthognathic Surgery. J. Pers. Med. 2023, 13, 1544.
- Paulsen HU, Karle A. Computer tomographic and radiographic changes in the temporomandibular joints of two young adults with occlusal asymmetry, treated with the Herbst appliance. Eur J Orthod. 2000;22:649-56.
- Méndez-Manjón I, Guijarro-Martínez R, Valls-Ontañón A, Hernández-Alfaro F. Early changes in condylar position after mandibular advancement: a three-dimensional analysis. Int J Oral Maxillofac Surg. 2016;45:787-92.
- Kim YI, Cho BH, Jung YH, Son WS, Park SB. Cone-beam computerized tomography evaluation of condylar changes and stability following two-jaw surgery: Le Fort I osteotomy and mandibular setback surgery with rigid fixation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:681-7.
- Panpitakkul P, Jorns TP, Kongsomboon S, Chaichit R, Sutthiprapaporn P. Three-Dimensional Changes of Condylar Position After Bimaxillary Surgery to Correct Skeletal III Malocclusion: Cone Beam Computed Tomography Voxel-Based Superimposition Analysis. J Oral Maxillofac Surg. 2024 Oct;82(10):1224-1238.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthodontics and Dentofacial Orthopaedics |
| Journal Section | RESEARCH ARTICLE |
| Authors | |
| Publication Date | April 28, 2025 |
| Submission Date | June 26, 2024 |
| Acceptance Date | November 24, 2024 |
| Published in Issue | Year 2025 Volume: 7 Issue: 1 |
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