Korean J Orthod.  2024 Jul;54(4):247-256. 10.4041/kjod23.188.

Evaluation of mandibular condyle position in Class III patients after bimaxillary orthognathic surgery: A cone-beam computed tomography study

• Küçükçakır O
• Ersan N
• Arslan YZ
• Cansız E

• KMID: 2558294
• DOI: http://doi.org/10.4041/kjod23.188

Abstract

Objective
This retrospective study evaluated the mandibular condyle position before and after bimaxillary orthognathic surgery performed with the mandibular condyle positioned manually in patients with mandibular prognathism using cone-beam computed tomography.
Methods
Overall, 88 mandibular condyles from 44 adult patients (20 female and 24 male) diagnosed with mandibular prognathism due to skeletal Class III malocclusion who underwent bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I performed using the manual condyle positioning method were included. Conebeam computed tomography images obtained 1–2 weeks before (T0) and approximately 6 months after (T1) surgery were analyzed in three planes using 3D Slicer software. Statistical significance was set at P < 0.05 level.
Results
Significant inward rotation of the left mandibular condyle and significant outward rotation of the right mandibular condyle were observed in the axial and coronal planes (P < 0.05). The positions of the right and left condyles in the sagittal plane and the distance between the most medial points of the condyles in the coronal plane did not differ significantly (P > 0.05).
Conclusions
While the change in the sagittal plane can be maintained as before surgery with manual positioning during the BSSRO procedure, significant inward and outward rotation was observed in the axial and coronal planes, respectively, even in the absence of concomitant temporomandibular joint disorder before or after the operation. Further long-term studies are needed to correlate these findings with possible clinical consequences.

Keyword

Bilateral sagittal split osteotomy; Manual condyle repositioning; Occlusal stability

Figure

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  Figure 1 Landmarks specified on the axial cone-beam computed tomography images to determine the condylar head position. A1R, the lateral pole of the right condylar head; A2R, the medial pole of the right condylar head; A1L, the lateral pole of the left condylar head; A2L, the medial pole of the left condylar head; BR, the most posterior point of the right carotid canal; BL, the most posterior point of the left carotid canal; Line1R, the line passes through A1R and A2R points; Line1L, the line passes through A1L and A2L points; Line2, the line which is passing through BL and BR points; α-angleR, the angle formed between Line1R and Line2; α-angleL, the angle formed between Line1L and Line2.

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  Figure 2 Landmarks specified on the sagittal cone-beam computed tomography images to determine the condylar head position. C1, the highest point of the glenoid fossa; C2, the highest point of the condylar head; D1, the lowest point of the articular eminence; D2, the lowest point of the temporal squamotympanic fissure; D3, the point of the line drawn perpendicular to Line3 from point C1; D4, the point of the line drawn perpendicular to Line3 from C2; M, the distance between D1 and D2; m, the distance between D1 and D4; N, the distance between C1 and D3; n, the distance between C2 and D4.

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  Figure 3 Landmarks specified on the coronal cone-beam computed tomography images to determine the condylar head position. ER, the highest point of the right glenoid fossa; EL, the highest point of the left glenoid fossa; F1R, the lateral pole of the right condylar head; F1L, the lateral pole of the left condyle head; F2R, the medial pole of the right condylar head; F2L, the medial pole of the left condylar head; Line4, passes through ER and EL; Line5R, passes through F1R and F2R points, and Line5L passes through F1L and F2L points; β-angleR, the angle between Line4 and Line5R; β-angleL, the angle between Line4 and Line5L, and C is the distance between F2R and F2L points.

• 

  Figure 4 Comparison of the pre-and postoperative α-angle. It is the angle between Line1 (passing through the lateral and medial pole points of the condylar head) and Line2 (passing through the rearmost points of the right and left carotid canal) in the axial plane. *Indicates statistical significance between the related pairs (P < 0.05).

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  Figure 5 Comparison of the pre-and postoperative n/N ratio. n/N, vertical evaluation rate of the mandibular condyle in the direction of the glenoid fossa.

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  Figure 6 Comparison of the pre-and postoperative m/M ratio. m/M, horizontal evaluation rate of the mandibular condyle in the direction of the glenoid fossa.

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  Figure 7 β-angle. It is the angle between the line passing through the lateral and medial pole points of the condylar head and the line passing through the highest points of the right and left glenoid fossa in the coronal plane. *Indicates statistical significance between the related pairs (P < 0.05).

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  Figure 8 The distance (C) between the condyle heads’ right and left lateral pole points.

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  Figure 9 Cone-beam computed tomography sections of a representative patient demonstrating A, B, T0 sagittal right and left; C, D, T1 sagittal right and left; E, F, T0 axial right and left; G, H, T1 axial right and left; I, T0 coronal; J, T1 coronal. In this particular patient, the condyles’ vertical downward movement and inward rotation were noted.

Reference

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