Researcher, PhD Candidate, Department of Preventive Dentistry, School of Dentistry, Institute of Oral Bioscience and BK 21 Plus Program, Jeonbuk National University, Jeonju, Republic of Korea; Clinical Fellow, Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University, Jeonju, Republic of Korea.
J Oral Maxillofac Surg. 2022 Jan;80(1):162-173. doi: 10.1016/j.joms.2021.08.146. Epub 2021 Aug 17.
This study aimed to evaluate the condylar position changes in 12 months after bilateral sagittal split ramus osteotomy (BSSO) with and without a Le Fort I osteotomy in patients with Class III malocclusion and the influence of the 2 surgical approaches on the condylar position.
In this prospective cohort study, patients with skeletal Class III malocclusion who underwent orthognathic surgery between 2017 and 2019 were included. The main predictive variable is the effect of increasing Le Fort I osteotomy on condyle position, which is divided into BSSO-only group and BSSO + Le Fort I osteotomy group. The main outcome variables were the displacement of the condylar head and the rotation/inclination of the condylar long axis before and after surgery. Other study variables were according to the degree of asymmetry of the left and right side of the mandible, the measured values of both sides were divided into mandibular deviation and nondeviation. The cone-beam volumetric imaging images were obtained before surgery (T1) and immediately after surgery (T2), 3 months (T3), 6 months (T4), and 12 months (T5) after surgery by computerized tomography (CT). One-way ANOVA and Tukey test was used for correlation analysis. The p-value is set to 0.05.
Twenty-four adult patients diagnosed with skeletal Class III malocclusion were included in this study, 12 patients (male/female = 6:6, mean age 21.8 years) who underwent BSSO + Le Fort I osteotomy and 12 patients (male/female = 6:6, mean age 19.8 years) who underwent BSSO-only. The position of the bilateral condylar head in both surgery groups was adjusted continuously during the 12 months after the operation. Immediately and 12 months after surgery, both sides of the condylar long axis in the BSSO with Le Fort I osteotomy group and the BSSO-only surgery group rotated inward, tilted forward, and tilted inward. In the BSSO with Le Fort I osteotomy group, the rotation and tilt angle changes of the condylar long axis on both sides were stable 6 months after surgery.
The addition of Le Fort I osteotomy did not significantly change the rotation and tilt direction of the condylar long axis and could accelerate the stability of the condylar long axis after BSSO surgery.
本研究旨在评估双侧下颌升支矢状劈开截骨术（BSSO）联合或不联合 Le Fort I 骨切开术治疗 III 类错畸形患者术后 12 个月时髁突位置的变化，并探讨这两种手术方法对髁突位置的影响。
本前瞻性队列研究纳入 2017 年至 2019 年间接受正颌手术的骨骼 III 类错畸形患者。主要预测变量是 Le Fort I 骨切开术对髁突位置的影响，将其分为仅行 BSSO 组和 BSSO 联合 Le Fort I 骨切开术组。主要结局变量为手术前后髁突头的位移和髁突长轴的旋转/倾斜。其他研究变量为根据下颌骨左右两侧的不对称程度，将两侧的测量值分为下颌骨偏斜和非偏斜。通过计算机断层扫描（CT），在术前（T1）、术后即刻（T2）、术后 3 个月（T3）、术后 6 个月（T4）和术后 12 个月（T5）获得锥形束容积成像图像。采用单因素方差分析和 Tukey 检验进行相关性分析。p 值设为 0.05。
本研究纳入了 24 例诊断为骨骼 III 类错畸形的成年患者，其中 12 例患者（男/女=6:6，平均年龄 21.8 岁）行 BSSO 联合 Le Fort I 骨切开术，12 例患者（男/女=6:6，平均年龄 19.8 岁）仅行 BSSO。术后 12 个月内，两组患者的双侧髁突头位置均持续调整。术后即刻和 12 个月时，BSSO 联合 Le Fort I 骨切开术组和 BSSO 单纯手术组的双侧髁突长轴均向内旋转、前倾和向内倾斜。在 BSSO 联合 Le Fort I 骨切开术组，术后 6 个月时双侧髁突长轴的旋转和倾斜角度变化稳定。
Le Fort I 骨切开术的加入并未显著改变髁突长轴的旋转和倾斜方向，并可加速 BSSO 术后髁突长轴的稳定性。
