Orthodontist, Private practice, Grand Rapids, Mich.
Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
Am J Orthod Dentofacial Orthop. 2021 Nov;160(5):705-717. doi: 10.1016/j.ajodo.2020.06.040. Epub 2021 Aug 2.
The objectives of this study were to evaluate postsurgical condylar remodeling using a radiographical interpretation, quantify condylar volumetric asymmetry, and assess soft tissue symmetry after simultaneous unilateral high condylectomy and bimaxillary osteotomies.
Sixteen patients diagnosed with unilateral condylar hyperplasia underwent unilateral high condylectomy and orthognathic surgery to correct skeletal and facial asymmetries. Cone-beam computed tomography scans were acquired before and 1-year after surgery. A radiographic consensus was evaluated for signs of reparative or degenerative changes. The condyles were mirrored and registered for assessment of volumetric and morphologic asymmetry. Soft tissue symmetry was evaluated by measurement of the distance of soft tissue pogonion from the skeletal midsagittal plane.
Patients who undergo unilateral high condylectomy and orthognathic surgery present radiographic signs suggestive of degenerative changes, including sclerosis, osteophytes, flattening, and erosion in both the surgical and nonsurgical condyles (P ≤0.01). There was an average volumetric improvement of 531.9 ± 662.3 mm 1-year postsurgery (P = 0.006). Soft tissue symmetry improved in all patients, with an average improvement of 65.8% (4.0 mm ± 2.6 mm, P ≤ 0.01). There was no correlation between the change in condylar volumetric asymmetry and the stability of the soft tissue correction.
High condylectomy for the correction of a skeletal asymmetry in patients with condylar hyperplasia successfully reduces the volumetric asymmetry between the condyles. Postsurgical dysmorphic remodeling and degenerative changes were noted in both the surgical and nonsurgical condyles. Despite remarkable changes and remaining joint asymmetry, the soft tissue correction is stable 1-year postsurgery.
本研究的目的是通过影像学解读评估术后髁突重塑，量化髁突体积不对称，并评估单侧高位髁突切除术和双颌骨截骨术后软组织的对称性。
16 例单侧髁突肥大患者行单侧高位髁突切除术和正颌手术矫正骨骼和面部不对称。术前和术后 1 年采集锥形束 CT 扫描。评估影像学共识以评估修复或退行性变化的迹象。将髁突镜像化并注册以评估体积和形态不对称。通过测量软组织颏顶点到骨骼正中矢状面的距离来评估软组织对称性。
行单侧高位髁突切除术和正颌手术的患者表现出退行性变化的影像学迹象，包括手术和非手术髁突的硬化、骨赘、变平、侵蚀（P≤0.01）。术后 1 年平均体积改善 531.9±662.3mm（P=0.006）。所有患者的软组织对称性均得到改善，平均改善 65.8%（4.0mm±2.6mm，P≤0.01）。髁突体积不对称的变化与软组织矫正的稳定性之间无相关性。
对于髁突肥大患者的骨骼不对称矫正，高位髁突切除术成功地减少了髁突之间的体积不对称。术后发现术侧和非术侧髁突存在畸形重塑和退行性改变。尽管发生了显著变化且关节仍存在不对称，但术后 1 年软组织矫正仍稳定。
