J Korean Assoc Oral Maxillofac Surg.  2021 Oct;47(5):373-381. 10.5125/jkaoms.2021.47.5.373.

Positional changes of the mandibular condyle in unilateral sagittal split ramus osteotomy combined with intraoral vertical ramus osteotomy for asymmetric class III malocclusion

• Park J
• Hong KE
• Yun JE
• Shin ES
• Kim CH
• Kim BJ
• Kim JH

• KMID: 2521793
• DOI: http://doi.org/10.5125/jkaoms.2021.47.5.373

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 (P=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.

Keyword

Orthognathic surgery; Facial asymmetry; Sagittal split ramus osteotomy; Intraoral vertical ramus osteotomy; Temporomandibular joint disorder

Figure

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  Fig. 1 Changes in the position of the deviated side condyle during osteotomy and fixation in bilateral sagittal split ramus osteotomy (BSSRO). A. Asymmetric mandible before osteotomy (left deviation). B. Mandible after osteotomy (reposition of the mandible on the midline of the face). C. Lateral displacement in the left condyle after fixation. During fixation of the left proximal segment to the distal segment, the condyle was displaced laterally due to bony interference.

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  Fig. 2 Three-dimensional (3D) computed tomography (CT) image superimposition for measuring condyle position change. A. Preoperative 3D CT image. B. Postoperative 3D CT image. C. Preoperative and postoperative image superimposition. The images were superimposed using important anatomical structures as landmarks.

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  Fig. 3 Measurement of condyle position change. A. Mediolateral and anteroposterior displacement. B. Condyle rotation. (Rt.: right, Ant.: anterior, Lat.: lateral, Post.: posterior, Med.: medial)

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  Fig. 4 Result of condyle position change between the two groups. A. Chin movement after surgery. B. Amount of displacement and rotation of the condyles on deviated side. C. Amount of displacement and rotation of the condyles on non-deviated side. *P<0.05. (Group I: patients who underwent intraoral vertical ramus osteotomy [IVRO] on the deviated side and sagittal split ramus osteotomy [SSRO] on the non-deviated side, Group II: patients who underwent bilateral SSRO with the bony interference grinding method)

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  Fig. 5 Digital panoramic and cephalometric radiograph of sagittal split ramus osteotomy (SSRO) with intraoral vertical ramus osteotomy (IVRO). A. Preoperative radiography. B. Postoperative radiography (right SSRO/left IVRO).

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  Fig. 6 Bilateral sagittal split ramus osteotomy (BSSRO) with bony interference grinding in a patient with asymmetric mandible (deviated side: left). A. Preoperative three-dimensional (3D) computed tomography (CT) image. B. Postoperative 3D CT image. Condylar displacement from the mandibular fossa is clearly observed on deviated side (left). (Rt.: right, Lt.: left)

Reference

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