Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3893, Japan.
Oral Maxillofac Surg. 2024 Mar;28(1):137-148. doi: 10.1007/s10006-023-01161-7. Epub 2023 Jun 6.
This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery.
The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed.
The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements.
This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements.
本研究旨在评估颞下颌关节（TMJ）盘位置与骨骼稳定性之间的相关性，并确定与双颌骨手术后复发相关的头影测量指标。
本研究纳入了 62 名患有颌骨畸形的女性患者（124 个关节），这些患者均接受了双颌骨手术。使用磁共振成像（MRI）对 TMJ 盘位置进行分类，分为前盘移位（ADD）、前位、完全覆盖和后位四种类型，并在术前、术后 1 周和 1 年进行头影测量分析。计算所有头影测量指标术前和术后 1 周（T1）以及术后 1 周和 1 年（T2）之间的差值。此外，还分析了使用头影测量指标、骨骼分类和 TMJ 盘位置与骨骼稳定性之间的关系。
本研究纳入的患者中，28 例为 II 类，34 例为 III 类。在 II 类下颌前伸病例和 III 类下颌后退病例中，SNB 在 T2 时存在显著差异（P = 0.0001）。在 T2 时，在髁突倾斜度方面，ADD 型和后位型之间存在显著差异（P = 0.0371）。逐步回归分析显示，T2 与所有测量指标的 T1 均呈显著相关。然而，TMJ 分类并非适用于所有测量指标。
本研究表明，TMJ 盘位置，包括 ADD，不会影响双颌骨截骨术后上颌骨和远移段的骨骼稳定性，并且所有测量指标的短期复发可能与手术引起的移动量或角度变化有关。
