Department of Craniofacial Orthodontics, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan.
Biomed Res Int. 2021 Aug 6;2021:1563551. doi: 10.1155/2021/1563551. eCollection 2021.
The aim of this study is to clarify the postsurgical stability of temporomandibular joints in skeletal class III patients treated with 2-jaw orthognathic surgery which was performed utilizing computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS) protocol.
23 consecutive nongrowing skeletal class III patients with mandibular prognathism associated with maxillary retrognathism treated with 2-jaw orthognathic surgery between 2018 and 2019 were enrolled in this study. The surgery was planned according to the standardized protocol of CASNOS (computer-aided three-dimensional simulation and navigation in orthognathic surgery). Computed tomography (CT) scans were performed in all patients 3 weeks presurgically and 6 months postsurgically. ITKSNAP and 3D Slicer software were used to reconstruct three-dimensional facial skeletal images, to carry out image segmentation, and to superimpose and quantify the TMJ position changes before and after surgery. Amount of displacement of the most medial and lateral points of the condyles and the change of intercondylar angles were measured to evaluate the postsurgical stability of TMJ.
A total amount of 23 skeletal class III patients (female : male = 12 : 11) with age ranged from 20.3 to 33.5 years (mean: 24.39 ± 4.8 years old) underwent Le Fort I maxillary advancement and BSSO setback of the mandible. The surgical outcome revealed the satisfactory correction of their skeletal deformities. The mean displacement of the right most lateral condylar point (RL-RL') was 1.04 ± 0.42 mm and the mean displacement of the left most lateral condylar point (LL-LL') was 1.19 ± 0.41 mm. The mean displacement of the right most medial condylar point (RM-RM') was 1.03 ± 0.39 mm and the left most medial condylar point (LM-LM') was 0.96 ± 0.39 mm. The mean intercondylar angle was 161.61 ± 5.08° presurgically and 159.28 ± 4.92° postsurgically.
The postsurgical position of TM joint condyles in our study only presented a mild change with all the landmark displacement within a range of 1.2 mm. This indicates the bimaxillary orthognathic surgery via 3D CASNOS protocol can achieve a desired and stable result of TMJ position in treating skeletal class III adult patients with retrognathic maxilla and prognathic mandible.
本研究旨在阐明利用计算机辅助三维模拟和导航正颌外科（CASNOS）方案进行双颌正颌手术治疗的骨骼 III 类患者颞下颌关节的术后稳定性。
本研究纳入了 2018 年至 2019 年间接受双颌正颌手术治疗的 23 例非生长性骨骼 III 类下颌前突伴上颌后缩患者。手术按照 CASNOS（计算机辅助三维模拟和导航正颌外科）的标准化方案进行规划。所有患者均在术前 3 周和术后 6 个月进行计算机断层扫描（CT）扫描。使用 ITKSNAP 和 3D Slicer 软件重建三维面部骨骼图像，进行图像分割，并叠加和量化手术前后 TMJ 位置的变化。测量髁突最内侧和最外侧点的位移量以及髁突间角的变化，以评估 TMJ 的术后稳定性。
共纳入 23 例骨骼 III 类患者（女：男=12：11），年龄 20.3 至 33.5 岁（平均 24.39±4.8 岁），行 Le Fort I 上颌骨前徙和 BSSO 下颌骨后退术。手术结果显示患者的骨骼畸形得到了满意的矫正。右侧最外侧髁突点（RL-RL'）的平均位移为 1.04±0.42mm，左侧最外侧髁突点（LL-LL'）的平均位移为 1.19±0.41mm。右侧最内侧髁突点（RM-RM'）的平均位移为 1.03±0.39mm，左侧最内侧髁突点（LM-LM'）的平均位移为 0.96±0.39mm。术前髁突间角平均为 161.61±5.08°，术后为 159.28±4.92°。
本研究中 TM 关节髁突的术后位置仅发生轻微变化，所有标志点的位移均在 1.2mm 范围内。这表明通过 3D CASNOS 方案进行双颌正颌手术可以实现治疗上颌后缩和下颌前突的成年骨骼 III 类患者 TMJ 位置的理想和稳定的效果。
