J Korean Assoc Oral Maxillofac Surg.  2017 Feb;43(1):23-28. 10.5125/jkaoms.2017.43.1.23.

Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction

• Mah DH
• Kim SG
• Oh JS
• You JS
• Jung SY
• Kim WG
• Yu KH

• KMID: 2385066
• DOI: http://doi.org/10.5125/jkaoms.2017.43.1.23

Abstract

OBJECTIVES
The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO).
MATERIALS AND METHODS
The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding).
RESULTS
The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm (P<0.01) forward movement and −0.87±0.57 mm (non-significant, NS) upward movement on the basis of point B and 2.54±1.37 mm (P<0.01) forward movement and −1.18±0.79 mm (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm (P<0.01) forward movement and −1.78±0.81 mm (P<0.01) upward movement on the basis of the point B and 4.11±1.93 mm (P<0.01) forward movement and −2.40±0.98 mm (P<0.01) upward movement on the basis of the Pog.
CONCLUSION
The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

Keyword

Deformity; Prognathism

MeSH Terms

Congenital Abnormalities
Humans
Mandible
Orthognathic Surgery*
Osteotomy, Sagittal Split Ramus*
Prognathism
Recurrence

Figure

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  Fig. 1 Superimposition of lateral cephalograms at the pre-surgery stage (T0; blue) and immediately after surgery (T1; red): B point and pogonion (Pog) point move backward and downward.

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  Fig. 2 Superimposition of lateral cephalograms immediately after surgery (T1; blue) and long-term after surgery (T2; orange): B point and pogonion (Pog) point move anterior and upward.

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  Fig. 3 Landmarks, reference planes, and measurements for cephalometric analysis. The landmarks: sella (S), porion (Por), orbitale (Or), pogonion (Pog), B point. The reference plane: Frankfort horizontal (FH) plane (Or-Por), perpendicular line of S to FH plane (S-perp). The linear measurements (mm): a, S-perp to Pog; b, S-perp to Pog; c, FH to B point; d, FH to Pog.

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