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Mandibular stability and condylar changes following orthognathic surgery in mandibular hypoplasia patients associated with preoperative condylar resorption

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Abstract

Objectives

To evaluate postoperative mandibular stability and condylar changes in patients with mandibular hypoplasia and preoperative condylar resorption (CR) undergoing orthognathic surgery.

Materials and methods

Fifty-four patients were included in this retrospective study. Computed tomography (CT) scans were acquired preoperatively (T0), 2–7 days immediate postoperatively (T1), and at least 1 year postoperatively (T2). Three-dimensional (3D) cephalometric analysis and measurements of condylar angle, volume, and position (joint spaces) were performed. A 2-mm mandibular relapse was deemed clinically acceptable. We also analyzed the correlations between relapse and postoperative CR and susceptible factors using a multivariate logistic regression model.

Results

The results showed one year after the surgery, the average mandibular relapse was 1.0 mm (p < 0.05), and the average reduction of condylar volume was 152.4 mm3 (12.7%). Condyle-fossa relationships were improved immediately after the surgery, with a tendency of returning to their original state in the follow-up (p < 0.05). Anteroposterior advancement at point B (B-CP advancement) at T1 and superior joint space (SJS) at T0 were significantly correlated with mandibular relapse, and postoperative CR was mainly associated with vertical increasement at point B (B-AP increasement) at T1. The optimal cut-off values were as follows: 1.6 mm for SJS, 4.2 mm for B-CP advancement, and 1.8 mm for B-AP increasement. Concomitant advancement Genioplasty showed no significant correlation with relapse and postoperative CR.

Conclusions

While patients with mandibular hypoplasia and preoperative CR were vulnerable to further condylar resorption after mandibular advancement, the treatment outcomes were generally clinically acceptable. Postoperative relapse was associated with a larger than 4.2 mm of mandibular advancement measured at B-CP and a larger than 1.6 mm of superior joint space measured at SJS, and postoperative CR was associated with a larger than 1.8 mm of mandibular vertical increasement measured at B-AP.

Clinical relevance

The findings of this study suggested that the mandibular advancement might be limited to 5 mm for patients with preoperative CR. A concomitant advancement genioplasty might also be considered to achieve a better facial profile in these patients.

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References

  1. Paunonen J, Helminen M, Peltomäki T (2018) Long-term stability of mandibular advancement with bilateral sagittal split osteotomy. J Craniomaxillofac Surg 46:1421–1426. https://doi.org/10.1016/j.jcms.2018.05.023

    Article  PubMed  Google Scholar 

  2. Rahman F, Celebi AA, Louis PJ, Kau CH (2019) A comprehensive treatment approach for idiopathic condylar resorption and anterior open bite with 3D virtual surgical planning and self-ligated customized lingual appliance. Am J Orthod Dentofacial Orthop 155:560–571. https://doi.org/10.1016/j.ajodo.2017.08.032

    Article  PubMed  Google Scholar 

  3. Wang H, Xue C, Luo E, Dai W, Shu R (2021) Three-dimensional surgical guide approach to correcting skeletal class II malocclusion with idiopathic condylar resorption. Angle Orthod 91:399–415. https://doi.org/10.2319/050320-383.1

    Article  PubMed  Google Scholar 

  4. Wolford LM, Reiche-Fischel O, Mehra P (2003) Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac Surg 61:655–660. https://doi.org/10.1053/joms.2003.50131 (discussion 661)

  5. Al-Riyami S, Cunningham SJ, Moles DR (2009) Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses. Am J Orthod Dentofacial Orthop 136:626.e1–16. https://doi.org/10.1016/j.ajodo.2009.02.022 (discussion 626-627)

  6. Li DTS, Leung YY (2021) Temporomandibular disorders: current concepts and controversies in diagnosis and management. Diagnostics (Basel) 11:459. https://doi.org/10.3390/diagnostics11030459

    Article  PubMed  Google Scholar 

  7. Tanaka E, Detamore MS, Mercuri LG (2008) Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res 87:296–307. https://doi.org/10.1177/154405910808700406

    Article  PubMed  Google Scholar 

  8. Wilkes CH (1989) Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg 115:469–477. https://doi.org/10.1001/archotol.1989.01860280067019

    Article  PubMed  Google Scholar 

  9. Wolford LM, Cardenas L (1999) Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes. Am J Orthod Dentofacial Orthop 116:667–677. https://doi.org/10.1016/s0889-5406(99)70203-9

    Article  PubMed  Google Scholar 

  10. Barone S, Cosentini G, Bennardo F, Antonelli A, Giudice A (2022) Incidence and management of condylar resorption after orthognathic surgery: an overview. Korean J Orthod 52:29–41. https://doi.org/10.4041/kjod.2022.52.1.29

    Article  PubMed  PubMed Central  Google Scholar 

  11. He Z, Ji H, Du W, Xu C, Luo E (2019) Management of condylar resorption before or after orthognathic surgery: a systematic review. J Craniomaxillofac Surg 47:1007–1014. https://doi.org/10.1016/j.jcms.2019.03.012

    Article  PubMed  Google Scholar 

  12. da Silva RJ, Valadares Souza CV, Souza GA, Ambrosano GMB, Freitas DQ, Sant’Ana E, de Oliveira-Santos C (2018) Changes in condylar volume and joint spaces after orthognathic surgery. Int J Oral Maxillofac Surg 47:511–517. https://doi.org/10.1016/j.ijom.2017.10.012

    Article  PubMed  Google Scholar 

  13. Hsu LF, Liu YJ, Kok SH, Chen YJ, Chen YJ, Chen MH, Jane Yao CC (2022) Differences of condylar changes after orthognathic surgery among class II and class III patients. J Formos Med Assoc 121:98–107. https://doi.org/10.1016/j.jfma.2021.01.018

    Article  PubMed  Google Scholar 

  14. Ehardt L, Ruellas A, Edwards S, Benavides E, Ames M, Cevidanes L (2021) Long-term stability and condylar remodeling after mandibular advancement: a 5-year follow-up. Am J Orthod Dentofacial Orthop 159:613–626. https://doi.org/10.1016/j.ajodo.2019.11.022

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shrestha A, Song SH, Aung HN, Sangwatanakul J, Zhou N (2021) Three-dimensional cephalometric analysis: the changes in condylar position pre- and post-orthognathic surgery with skeletal class III malocclusion. J Craniofac Surg 32:546–551. https://doi.org/10.1097/scs.0000000000006873

    Article  PubMed  Google Scholar 

  16. Möhlhenrich SC, Winterhalder P, Ooms M, Heitzer M, Kilic K, Prescher A, Hölzle F, Danesh G, Modabber A (2021) Changes in the temporomandibular joint position depending on the sagittal osteotomy technique and extent of mandibular movement. Int J Oral Maxillofac Surg 50:356–366. https://doi.org/10.1016/j.ijom.2020.06.009

    Article  PubMed  Google Scholar 

  17. Miao MZ, Wang B, Wu D, Zhang S, Wong S, Shi O, Hu A, Mao L, Fang B (2018) Temporomandibular joint positional change accompanies post-surgical mandibular relapse-a long-term retrospective study among patients who underwent mandibular advancement. Orthod Craniofac Res 21:33–40. https://doi.org/10.1111/ocr.12209

    Article  PubMed  Google Scholar 

  18. Ueki K, Yoshizawa K, Saito Y, Takayama A, Baba N, Kimura Y, Koizumi M, Fujimoto K, Iguchi R, Sato M, Osada AH, Moroi A (2021) Evaluation of condylar surface CT values related to condylar height reduction after orthognathic surgery. J Craniomaxillofac Surg 49:639–648. https://doi.org/10.1016/j.jcms.2021.01.005

    Article  PubMed  Google Scholar 

  19. Beukes J, Reyneke JP, Becker PJ (2013) Medial pterygoid muscle and stylomandibular ligament: the effects on postoperative stability. Int J Oral Maxillofac Surg 42:43–48. https://doi.org/10.1016/j.ijom.2012.05.010

    Article  PubMed  Google Scholar 

  20. Yang HJ, Hwang SJ (2015) Bone mineral density and mandibular advancement as contributing factors for postoperative relapse after orthognathic surgery in patients with preoperative idiopathic condylar resorption: a prospective study with preliminary 1-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol 120:112–118. https://doi.org/10.1016/j.oooo.2015.03.004

    Article  PubMed  Google Scholar 

  21. Xi T, Schreurs R, van Loon B, de Koning M, Berge S, Hoppenreijs T, Maal T (2015) 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies. J Craniomaxillofac Surg 43:462–468. https://doi.org/10.1016/j.jcms.2015.02.006

    Article  PubMed  Google Scholar 

  22. Yuan M, Xie Q, Shen P, Yang C (2021) Low skeletal bone mineral density as a potential aetiological factor towards idiopathic condylar resorption. Int J Oral Maxillofac Surg 50:665–669. https://doi.org/10.1016/j.ijom.2020.09.027

    Article  PubMed  Google Scholar 

  23. Nicolielo LFP, Jacobs R, Ali Albdour E, Hoste X, Abeloos J, Politis C, Swennen G (2017) Is oestrogen associated with mandibular condylar resorption? A systematic review. Int J Oral Maxillofac Surg 46:1394–1402. https://doi.org/10.1016/j.ijom.2017.06.012

    Article  PubMed  Google Scholar 

  24. Steiner CC (1953) Cephalometrics for you and me. Am J Orthod 39:729–755. https://doi.org/10.1016/0002-9416(53)90082-7

    Article  Google Scholar 

  25. Xia JJ, Gateno J, Teichgraeber JF, Yuan P, Chen KC, Li J, Zhang X, Tang Z, Alfi DM (2015) Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence. Int J Oral Maxillofac Surg 44:1431–1440. https://doi.org/10.1016/j.ijom.2015.06.006

    Article  PubMed  PubMed Central  Google Scholar 

  26. Xia JJ, Gateno J, Teichgraeber JF, Yuan P, Li J, Chen KC, Jajoo A, Nicol M, Alfi DM (2015) Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry. Int J Oral Maxillofac Surg 44:1441–1450. https://doi.org/10.1016/j.ijom.2015.06.007

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hsu SS-P, Gateno J, Bell RB, Hirsch DL, Markiewicz MR, Teichgraeber JF, Zhou X, Xia JJ (2013) Accuracy of a computer-aided surgical simulation protocol for orthognathic surgery: a prospective multicenter study. J Oral Maxillofac Surg 71:128–142. https://doi.org/10.1016/j.joms.2012.03.027

    Article  PubMed  Google Scholar 

  28. Ha N, Hong Y, Qu L, Chung M, Qu R, Cai X, Fang B, Jiang L (2020) Evaluation of post-surgical stability in skeletal class II patients with idiopathic condylar resorption treated with functional splint therapy. J Craniomaxillofac Surg 48:203–210. https://doi.org/10.1016/j.jcms.2020.01.004

    Article  PubMed  Google Scholar 

  29. Pullinger A, Hollender L (1986) Variation in condyle-fossa relationships according to different methods of evaluation in tomograms. Oral Surg Oral Med Oral Pathol 62:719–727. https://doi.org/10.1016/0030-4220(86)90270-7

    Article  PubMed  Google Scholar 

  30. van der Linden C, van der Linden WJ, Reyneke JP (2015) Skeletal stability following mandibular advancement with and without advancement genioplasty. Int J Oral Maxillofac Surg 44:621–626. https://doi.org/10.1016/j.ijom.2014.11.002

    Article  PubMed  Google Scholar 

  31. Catherine Z, Breton P, Bouletreau P (2016) Management of dentoskeletal deformity due to condylar resorption: literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 121:126–132. https://doi.org/10.1016/j.oooo.2015.08.013

    Article  PubMed  Google Scholar 

  32. Hoppenreijs TJ, Freihofer HP, Stoelinga PJ, Tuinzing DB, van’t Hof MA, (1998) Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite. A clinical and radiological study. Int J Oral Maxillofac Surg 27:81–91. https://doi.org/10.1016/s0901-5027(98)80301-9

    Article  PubMed  Google Scholar 

  33. Huang YL, Pogrel MA, Kaban LB (1997) Diagnosis and management of condylar resorption. J Oral Maxillofac Surg 55:114–119. https://doi.org/10.1016/s0278-2391(97)90222-6 (discussion 119-120)

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Funding

The work was supported by the National Key R&D Program of China (no. 2017YFB1104100); Shanghai Sailing Program (no. 19YF1426500); Clinical Research Project of Multi-Disciplinary Team, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine (no. 201912).

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Author notes

  1. HongboYu and Steve GF. Shen contributed equally.

Authors and Affiliations

  1. Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, 200011, Shanghai, China

    Minjiao Wang, Yifeng Qian, Hanjiang Zhao, Min Zhu, Hongbo Yu & Steve GF. Shen

  2. Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China

    Steve GF. Shen

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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Minjiao Wang, Yifeng Qian, Hanjiang Zhao, and Min Zhu. The first draft of the manuscript was written by Minjiao Wang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hongbo Yu or Steve GF. Shen.

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Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. An ethics approval with an official waiver of informed consent was granted from the Institutional Review Board of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine (No: SH9H-2021-T303-2). This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Approved with wavier of informed consent owing to the study’s retrospective nature.

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The authors declare no competing interests.

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Dr. Minjiao Wang is the first author.

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Wang, M., Qian, Y., Zhao, H. et al. Mandibular stability and condylar changes following orthognathic surgery in mandibular hypoplasia patients associated with preoperative condylar resorption. Clin Oral Invest 26, 7083–7093 (2022). https://doi.org/10.1007/s00784-022-04668-7

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