Wang Ziyu, Shi Yijin, Wang Yi, Chen Wenjing, Jiang Hongbing, Cheng Jie
Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Jiangsu, 210029, People's Republic of China.
Clin Oral Investig. 2023 Jul;27(7):4061-4071. doi: 10.1007/s00784-023-05032-z. Epub 2023 May 5.
The present study aimed to characterize three-dimensional (3D) long-term quantitative condyle change including positional, surface, and volumetric alterations in patients with skeletal class III malocclusion treated with bimaxillary orthognathic surgery.
Twenty-three eligible patients (9 males, 14 females, mean age: 28.28 years old) treated from Jan. 2013 to Dec. 2016 with postoperative follow-up over 5 years were retrospectively enrolled. Cone-beam computed tomography scan for each patient was conducted at 4 stages: 1 week preoperatively (T0), immediately after surgery (T1), 12 months postoperatively (T2), and 5-year postoperatively (T3). Positional changes, surface, and volumetric remodeling of condyle were measured in segmented visual 3D models and statistically compared between stages.
Our 3D quantitative calibrations revealed that the condylar center shifted in anterior (0.23 ± 1.50 mm), medial (0.34 ± 0.99), and superior (1.11 ± 1.10 mm) directions and rotated outward (1.58 ± 3.11°), superior (1.83 ± 5.08°), and backward (4.79 ± 13.75°) from T1 to T3. With regard to condylar surface remodeling, bone formation was frequently observed in the anteromedial areas, while bone resorption was commonly detected in the anterolateral area. Moreover, condylar volume remained largely stable with a minimal reduction during the follow-up.
Collectively, although condyle undergoes positional changes and bone remodeling after bimaxillary surgery in patients with mandibular prognathism, these changes largely fall in the range of physical adaptations in the long run.
These findings advance the current understanding of long-term condylar remodeling after bimaxillary orthognathic surgery in skeletal class III patients.
本研究旨在描述接受双颌正颌手术治疗的Ⅲ类骨性错牙合患者髁突的三维（3D）长期定量变化，包括位置、表面和体积改变。
回顾性纳入2013年1月至2016年12月期间接受治疗且术后随访超过5年的23例符合条件的患者（9例男性，14例女性，平均年龄：28.28岁）。对每位患者在4个阶段进行锥形束计算机断层扫描：术前1周（T0）、术后即刻（T1）、术后12个月（T2）和术后5年（T3）。在分割的可视化3D模型中测量髁突的位置变化、表面和体积重塑，并在各阶段之间进行统计学比较。
我们的3D定量校准显示，从T1到T3，髁突中心向前（0.23±1.50mm）、向内（0.34±0.99）和向上（1.11±1.10mm）移位，并向外（1.58±3.11°）、向上（1.83±5.08°）和向后（4.79±13.75°）旋转。关于髁突表面重塑，在前内侧区域经常观察到骨形成，而在前外侧区域通常检测到骨吸收。此外，髁突体积在随访期间基本保持稳定，仅有轻微减少。
总体而言，尽管下颌前突患者在双颌手术后髁突会发生位置变化和骨重塑，但从长远来看，这些变化大多在身体适应范围内。
这些发现推进了目前对Ⅲ类骨骼患者双颌正颌手术后髁突长期重塑的理解。
