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III类双颌正颌手术患者髁突位置和体积参数及骨骼稳定性的长期评估

Long-term evaluation of condylar positional and volumetric parameters and skeletal stability in Class III bimaxillary orthognathic surgery patients.

作者信息

Podcernina J, Jakobsone G, Urtane I, Salms G, Radzins O

机构信息

Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia.

Department of Orthodontics, Institute of Stomatology, Rīga Stradiņš University, Rīga, Latvia.

出版信息

Int J Oral Maxillofac Surg. 2024 Aug;53(8):707-714. doi: 10.1016/j.ijom.2024.01.013. Epub 2024 Feb 20.

Abstract

This retrospective study examined long-term (4-5 years) condylar positional and volumetric changes and skeletal stability after bimaxillary orthognathic surgery in skeletal Class III patients. Pre-surgical (T0: 0.9 ± 1.1 months) and post-surgical (T1: 0.6 ± 0.7 months; T2: 12.8 ± 3.1 months; T3: 56.5 ± 6.5 months) cone beam computed tomography (CBCT) images of 22 patients were obtained. CBCT multiplanar reformation (MPR) images were generated, and three-dimensional (3D) condylar models were constructed and superimposed to compare changes in condylar volume from pre- to postoperative. Condylar position in the sagittal and coronal planes altered immediately after surgery; however at long-term follow-up, the condyles had returned to their pre-surgical position. The condyles remained slightly inwardly rotated at short-term (-2.6°, 95% confidence interval -3.5° to -1.7°) and long-term (-1.9°, 95% confidence interval -2.8° to -1.0°) follow-up. Changes in condylar volume were insignificant after surgery. Condylar positional changes had no effect on skeletal stability. However, patients with an increased face height prior to surgery and more retrusive jaw position postoperatively were more prone to condylar resorption. Surgical changes remained stable 4-5 years after surgery. In conclusion, condylar position changed insignificantly following surgical correction in Class III patients provided that the correct surgical technique was employed.

摘要

这项回顾性研究调查了骨骼Ⅲ类患者双颌正颌手术后髁突的长期(4 - 5年)位置和体积变化以及骨骼稳定性。获取了22例患者术前(T0:0.9 ± 1.1个月)和术后(T1:0.6 ± 0.7个月;T2:12.8 ± 3.1个月;T3:56.5 ± 6.5个月)的锥形束计算机断层扫描(CBCT)图像。生成了CBCT多平面重建(MPR)图像,并构建和叠加三维(3D)髁突模型以比较术前至术后髁突体积的变化。术后矢状面和冠状面的髁突位置立即改变;然而,在长期随访中,髁突已恢复到术前位置。在短期(-2.6°,95%置信区间-3.5°至-1.7°)和长期(-1.9°,95%置信区间-2.8°至-1.0°)随访中,髁突仍保持轻微内旋。术后髁突体积变化不显著。髁突位置变化对骨骼稳定性没有影响。然而,术前面高增加且术后颌骨位置更后缩的患者更容易发生髁突吸收。手术后4 - 5年手术变化保持稳定。总之,对于Ⅲ类患者,如果采用正确的手术技术,手术矫正后髁突位置变化不显著。

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