Ohba S, Shido R, Naruse T, Narahara S, Yamada T
Department of Oral and Maxillofacial Surgery, Showa University School of Dentistry, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Int J Oral Maxillofac Surg. 2025 Aug;54(8):727-732. doi: 10.1016/j.ijom.2025.01.011. Epub 2025 Jan 29.
This study was performed to investigate the impact of the split line on postoperative stability and temporomandibular joint (TMJ) disorders (TMD) after sagittal split ramus osteotomy. Skeletal Class III malocclusion patients who underwent mandibular osteotomy with/without plate fixation between August 2008 and March 2023 were enrolled retrospectively. The osteotomy lines were divided into original sagittal split ramus (SSRO), short lingual (SLO), and short buccal (SBO) osteotomies. Skeletal stability was evaluated, and TMDs were assessed preoperatively. Overall, 135 patients (270 TMJs) (87 female, 48 male; mean age 23.7 ± 7.8 years) were included. Mean mandibular setback was 6.2 ± 2.9 mm. Skeletal stability was observed in all patients. TMD were recorded in 47 joints (17.4%) preoperatively and 15 joints (5.6%) postoperatively. When TMD were compared between joints with and without plate fixation, preoperative TMD was found to be improved in non-fixed joints (P = 0.004). On multivariate analysis, segment fixation (P = 0.040), the osteotomy line (SBO vs SLO/SSRO, P = 0.043), and preoperative TMD (P = 0.030) were associated with postoperative TMD. The results of this study suggest that no plate fixation after mandibular osteotomy may be beneficial when the split line is SBO or preoperative TMD is observed.
本研究旨在探讨矢状劈开下颌支截骨术后劈开线对术后稳定性及颞下颌关节紊乱病（TMD）的影响。对2008年8月至2023年3月期间接受下颌骨截骨术并伴有或不伴有钢板固定的骨性III类错牙合患者进行回顾性研究。截骨线分为原始矢状劈开下颌支（SSRO）、短舌侧（SLO）和短颊侧（SBO）截骨术。评估骨骼稳定性，并在术前评估TMD。总共纳入了135例患者（270个颞下颌关节）（87例女性，48例男性；平均年龄23.7±7.8岁）。平均下颌后缩为6.2±2.9mm。所有患者均观察到骨骼稳定性。术前47个关节（17.4%）记录有TMD，术后15个关节（5.6%）记录有TMD。当比较有钢板固定和无钢板固定的关节之间的TMD时，发现非固定关节的术前TMD有所改善（P = 0.004）。多因素分析显示，节段固定（P = 0.040）、截骨线（SBO与SLO/SSRO相比，P = 0.043）和术前TMD（P = 0.030）与术后TMD相关。本研究结果表明，当下颌骨截骨术后劈开线为SBO或观察到术前TMD时，不进行钢板固定可能是有益的。
