Verhelst Pieter-Jan, Janssens Sigrid, Matthews Harold, Begnoni Giacomo, Claes Peter, Shaheen Eman, Peeters Hilde, Politis Constantinus, Jacobs Reinhilde
OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
Sci Rep. 2025 Jan 3;15(1):664. doi: 10.1038/s41598-024-81148-w.
Condylar resorption is a feared complication of orthognathic surgery. This study investigated condylar resorption in a cohort of 200 patients This allowed for a powerful update on incidence and risk factors. 9.5% of patients developed resorption. These patients had on average, 17% volume loss with 3.9 mm ramal height loss and 3.1 mm posterior mandibular displacement. 2% of patients had bilateral resorption. Univariable analysis identified a younger age, a bimaxillary + genioplasty procedure, larger mandibular advancements, upward movements of the distal segment, a higher counterclockwise pitch of the distal segment, smaller preoperative condylar volumes and a higher anterior/posterior lower facial height ratio as risk factors on a patient level. Univariable analysis on a condylar level also identified compressive movements of the ramus and a higher mandibular plane angle as risk factors. Using machine learning for the multivariable analysis, the amount of mandibular advancement was the most important predictor for condylar resorption. There were no differences in preoperative mandibular, ramal or condylar shape between patients with or without resorption. These findings suggest condylar resorption may be more common than thought. Identifying risk factors allows surgical plans to be adjusted to reduce the likelihood of resorption, and patients can be more selectively screened postoperatively.
髁突吸收是正颌外科手术令人担忧的并发症。本研究调查了200例患者队列中的髁突吸收情况。这使得我们能够有力地更新髁突吸收的发生率及风险因素。9.5%的患者发生了吸收。这些患者平均有17%的体积丢失，升支高度丢失3.9毫米，下颌后份移位3.1毫米。2%的患者双侧发生吸收。单因素分析确定在患者层面，年龄较小、双颌 + 颏成形术、较大的下颌前徙量、远心骨段向上移动、远心骨段逆时针旋转角度较大、术前髁突体积较小以及面下高的前后径比值较高为风险因素。在髁突层面的单因素分析还确定升支的挤压运动和较高的下颌平面角为风险因素。使用机器学习进行多因素分析，下颌前徙量是髁突吸收最重要的预测因素。发生吸收和未发生吸收的患者术前下颌、升支或髁突形态无差异。这些发现表明髁突吸收可能比想象的更常见。识别风险因素有助于调整手术方案以降低吸收的可能性，并且可以在术后对患者进行更有针对性的筛查。
