Ohba Seigo, Tominaga Junya, Shido Rena, Koga Takamitsu, Yamamoto Hideyuki, Zaiima Hirotaka, Yoshida Noriaki, Asahina Izumi
Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588 Japan.
Department of Orthodontics and Dentofacial Orthopedics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588 Japan.
J Craniomaxillofac Surg. 2022 Sep;50(9):712-718. doi: 10.1016/j.jcms.2022.07.009. Epub 2022 Aug 1.
The aim of this study was to clarify the effects of three different orthognathic surgical procedures on the temporomandibular joint after mandibular setback. Conventional sagittal split ramus osteotomy (SSRO) with segmental fixation (conv-SSRO), intraoral vertical ramus osteotomy (IVRO), or SSRO without fixation followed by the physiological positioning strategy (nonfix-SSRO) was performed for mandibular setback. Temporomandibular joint disorder (TMD) symptoms were clinically assessed, and the condylar head angle was measured. In total, 129 patients participated. Preoperative TMD and treatment procedure were related to postoperative TMD. A menton deviation of 3.43 mm was the cutoff for the risk of postoperative TMD. The incidence rate of postoperative TMD in the conv-SSRO group was higher than that in the IVRO (p = 0.0197) and nonfix-SSRO (p = 0.0001) groups in asymmetric cases. There was no significant postoperative change in the temporomandibular joint space in each group. In symmetric and asymmetric cases, the condylar head was rotated inwards by 5.82 ± 4.75° (p < 0.0001) and 5.44 ± 3.10° (p < 0.0001), respectively, in the conv-SSRO group, and outwards by -7.98 ± 5.05° (p < 0.0001) and -8.32 ± 6.38° (p < 0.0001), respectively, in the IVRO group, but it was almost stable in the nonfix-SSRO group. Within the limitations of the study it seems that nonfix-SSRO should be preferred over conv-SSRO and IVRO whenever appropriate.
本研究旨在阐明三种不同正颌外科手术在下颌后缩后对颞下颌关节的影响。采用传统的带节段固定的矢状劈开下颌升支截骨术（conv-SSRO）、口内垂直下颌升支截骨术（IVRO）或不固定的矢状劈开下颌升支截骨术并采用生理定位策略（nonfix-SSRO）进行下颌后缩手术。对颞下颌关节紊乱（TMD）症状进行临床评估，并测量髁突角。共有129例患者参与。术前TMD和治疗方法与术后TMD有关。颏点偏差3.43mm是术后TMD风险的临界值。在不对称病例中，conv-SSRO组术后TMD的发生率高于IVRO组（p = 0.0197）和nonfix-SSRO组（p = 0.0001）。每组颞下颌关节间隙术后均无显著变化。在对称和不对称病例中，conv-SSRO组髁突分别向内旋转5.82±4.75°（p < 0.0001）和5.44±3.10°（p < 0.0001），IVRO组髁突分别向外旋转-7.98±5.05°（p < 0.0001）和-8.32±6.38°（p < 0.0001），但nonfix-SSRO组髁突几乎稳定。在本研究的局限性范围内，似乎在适当的时候，nonfix-SSRO比conv-SSRO和IVRO更可取。
