Goncalves Joao Roberto, Wolford Larry Miller, Cassano Daniel Serra, da Porciuncula Guilherme, Paniagua Beatriz, Cevidanes Lucia Helena
Department of Pediatric Dentistry, Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista, Araraquara, Brazil.
J Oral Maxillofac Surg. 2013 Oct;71(10):1759.e1-15. doi: 10.1016/j.joms.2013.06.209.
To evaluate condylar changes 1 year after bimaxillary surgical advancement with or without articular disc repositioning using longitudinal quantitative measurements in 3-dimensional (3D) temporomandibular joint (TMJ) models.
Twenty-seven patients treated with maxillomandibular advancement (MMA) underwent cone-beam computed tomography before surgery, immediately after surgery, and at 1-year follow-up. All patients underwent magnetic resonance imaging before surgery to assess disc displacements. Ten patients without disc displacement received MMA only. Seventeen patients with articular disc displacement received MMA with simultaneous TMJ disc repositioning (MMA-Drep). Pre- and postsurgical 3D models were superimposed using a voxel-based registration on the cranial base.
The location, direction, and magnitude of condylar changes were displayed and quantified by graphic semitransparent overlays and 3D color-coded surface distance maps. Rotational condylar displacements were similar in the 2 groups. Immediately after surgery, condylar translational displacements of at least 1.5 mm occurred in a posterior, superior, or mediolateral direction in patients treated with MMA, whereas patients treated with MMA-Drep presented more marked anterior, inferior, and mediolateral condylar displacements. One year after surgery, more than half the patients in the 2 groups presented condylar resorptive changes of at least 1.5 mm. Patients treated with MMA-Drep presented condylar bone apposition of at least 1.5 mm at the superior surface in 26.4%, the anterior surface in 23.4%, the posterior surface in 29.4%, the medial surface in 5.9%, or the lateral surface in 38.2%, whereas bone apposition was not observed in patients treated with MMA.
One year after surgery, condylar resorptive changes greater than 1.5 mm were observed in the 2 groups. Articular disc repositioning facilitated bone apposition in localized condylar regions in patients treated with MMA-Drep.
利用三维（3D）颞下颌关节（TMJ）模型进行纵向定量测量，评估双颌手术前徙联合或不联合关节盘复位术后1年髁突的变化情况。
27例接受上颌下颌前徙术（MMA）的患者在手术前、手术后即刻以及术后1年接受锥形束计算机断层扫描。所有患者在手术前接受磁共振成像以评估关节盘移位情况。10例无关节盘移位的患者仅接受MMA。17例有关节盘移位的患者接受MMA同时进行TMJ关节盘复位术（MMA-Drep）。术前和术后的3D模型在颅底上使用基于体素的配准进行叠加。
通过图形半透明叠加和3D彩色编码表面距离图展示并量化髁突变化的位置、方向和大小。两组的髁突旋转位移相似。手术后即刻，接受MMA治疗的患者髁突至少有1.5 mm的向后、向上或中外侧平移位移，而接受MMA-Drep治疗的患者髁突出现更明显的向前、向下和中外侧位移。手术后1年，两组中超过一半的患者出现至少1.5 mm的髁突吸收变化。接受MMA-Drep治疗的患者中，26.4%的患者在上表面、23.4%的患者在前表面、29.4%的患者在后表面、5.9%的患者在内表面或38.2%的患者在外表面出现至少1.5 mm的髁突骨质增生，而接受MMA治疗的患者未观察到骨质增生。
手术后1年，两组均观察到大于1.5 mm的髁突吸收变化。关节盘复位有助于接受MMA-Drep治疗的患者在局部髁突区域出现骨质增生。
