Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Eiveniu Str. 2, 44307 Kaunas, Lithuania.
Medicina (Kaunas). 2024 Oct 14;60(10):1683. doi: 10.3390/medicina60101683.
The most popular surgical procedures among orthognathic surgeries for Class II and III patients are Le Fort 1 osteotomy for the maxilla and bilateral sagittal split ramus osteotomy (BSSRO) for the mandible. Keeping the condyle in its proper place during fixation is one of the difficulties of orthognathic surgery. One of the worst post-orthognathic surgery consequences in the temporomandibular joint (TMJ) area may be condylar resorption. Condylar remodeling refers to a group of processes that occur in reaction to forces and stress placed on the temporomandibular joint in order to preserve morphological, functional, and occlusal balance. A systematic review of the literature was performed with the aim of identifying the mandibular condylar component of TMJ changes after orthognathic surgery in class II and III patients. An electronic search was carried out using the PubMed, Cochrane Library, and Google Scholar, databases. The inclusion criteria included trials in non-growing patients upon whom orthognathic surgery was performed due to Angle II or Angle III classes malocclusion; in addition, a CT or cone beam computed tomography (CBCT) scan was performed before and after surgery to track the mandibular condylar component of TMJ changes. The quality of the studies was evaluated by two independent authors. The risk of bias was assessed by using the Downs and Black checklist. The electronic and manual literature search yielded 12 studies that fulfilled all necessary inclusion criteria. Observed studies were evaluated as good (3), fair (8), and poor (1) quality. Two studies evaluated class II patients, six studies observed class III patients, and four studies were comparative. Most of the studies evaluated condyle angle and space changes, and the condylar surface and volume changes were also observed. However, the methodology of evaluation in the publications differs. Reduction of bone density, especially in class II patients, and morphological condyle reshaping, with the apposition of the bone, is the main adaptive mechanism after orthognathic surgery. However, all of the studies we examined were conducted using different methods of evaluation, measurement, and reference points.
正颌手术中，针对 II 类和 III 类患者最常进行的手术是上颌 Le Fort 1 截骨术和下颌双侧矢状劈开截骨术（BSSRO）。在固定过程中使髁突保持在适当位置是正颌手术的难点之一。正颌手术后颞下颌关节（TMJ）区域最严重的后果之一可能是髁突吸收。髁突改建是指一组发生在颞下颌关节的力和应力作用下，为了保持形态、功能和咬合平衡而发生的过程。本文对文献进行了系统回顾，旨在确定 II 类和 III 类错颌患者正颌手术后 TMJ 变化中的下颌髁突成分。使用 PubMed、Cochrane 图书馆和 Google Scholar 数据库进行电子搜索。纳入标准包括对因安氏 II 类或安氏 III 类错颌而接受正颌手术的非生长患者进行的试验；此外，在手术前后进行 CT 或锥形束 CT（CBCT）扫描以跟踪 TMJ 变化中的下颌髁突成分。两位独立作者评估了研究的质量。使用 Downs 和 Black 清单评估偏倚风险。电子和手动文献检索共获得 12 项符合所有必要纳入标准的研究。观察到的研究被评估为良好（3）、中等（8）和较差（1）质量。两项研究评估了 II 类患者，六项研究观察了 III 类患者，四项研究为比较性研究。大多数研究评估了髁突角度和空间变化，也观察了髁突表面和体积变化。然而，出版物中的评估方法存在差异。骨密度降低，尤其是在 II 类患者中，以及形态学髁突重塑，伴随着骨的堆积，是正颌手术后的主要适应机制。然而，我们检查的所有研究都使用了不同的评估、测量和参考点方法。
