Department of Oral and Maxillofacial Surgery (Head: Prof. Byung-Joon Choi), School of Dentistry, Kyung Hee University, 02447, Seoul, Republic of Korea.
Department of Oral and Maxillofacial Surgery (Head: Prof. Byung-Joon Choi), School of Dentistry, Kyung Hee University, 02447, Seoul, Republic of Korea.
J Craniomaxillofac Surg. 2018 Sep;46(9):1470-1475. doi: 10.1016/j.jcms.2018.06.001. Epub 2018 Jun 8.
The aim of this study was to assess condylar resorption, spatial change in glenoid cavity, and its risk factors after mandibular advancement by three-dimensional volumetric analysis. Subjects consisted of 30 condyles of 15 patients diagnosed with mandibular retrognathism who underwent Le Fort I and bilateral sagittal split ramus osteotomy advancement. CBCT images were taken before surgery (T0), immediately after surgery (T1), and postoperatively at 6 months (T2) and 1 year (T3). Condylar resorption was observed in 21 condyles. The posterior was the most affected region, while the anterior was the least affected. The volume of the glenoid cavity was significantly increased after surgery regardless of the presence or absence of resorption. However, the cavity recovered close to its original volume over time. At 1 year after surgery, the volume was not significantly different from the preoperative volume. Counterclockwise rotation of the proximal segment was found to be a risk factor affecting resorption based on correlation analysis. Mandibular advancement appeared to generate excessive mechanical stress on the posterior condyle, and might be responsible for the resorption. Counterclockwise rotation might have added stress to the region. Articular spatial change was transient and did not appear to be related to condyle resorption.
本研究旨在通过三维容积分析评估下颌前伸术后髁突吸收、颞下颌关节窝的空间变化及其危险因素。研究对象为 15 例下颌后缩患者的 30 个髁突,这些患者均接受 Le Fort I 型截骨术和双侧下颌升支矢状劈开截骨术。在术前(T0)、术后即刻(T1)、术后 6 个月(T2)和 1 年(T3)时拍摄 CBCT 图像。结果发现 21 个髁突发生了吸收。最易受影响的区域是髁突后份,而最不受影响的区域是髁突前份。无论是否发生吸收,术后颞下颌关节窝的体积均显著增加。然而,随着时间的推移,关节窝逐渐恢复到接近原始体积。术后 1 年时,关节窝的体积与术前相比无显著差异。相关性分析显示,近中端的逆时针旋转是影响吸收的危险因素。下颌前伸似乎会给髁突后份带来过度的机械应力,这可能是导致吸收的原因。而逆时针旋转可能会给该区域增加额外的应力。关节的空间变化是短暂的,似乎与髁突吸收无关。