Zhang Chi, Xu Yule, Wei Yuxiang, Li Yuan, Guo Songsong, Jiang Hongbing, Wang Dongmiao, Cheng Jie
Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Jiangsu, 210029, China.
State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, Nanjing Medical University, Jiangsu, 210029, China.
Clin Oral Investig. 2025 Jun 23;29(7):348. doi: 10.1007/s00784-025-06432-z.
The present study was aimed to assess three-dimensional (3D) quantitative changes of condyle in patients with Class III facial asymmetry after bimaxillary orthognathic surgery.
Fifty-five eligible patients with Class III facial asymmetry received Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) with or without genioplasty from January 2020 to June 2022 were included. Cone-beam computed tomography (CBCT) for each patient was collected at 3 stages: 1 week preoperatively (T0), immediately after surgery (T1) and at least 12 months postoperatively (T2). Positional changes and bone remodeling of condyles were measured based on voxel- and surface-registrations using ITK-SNAP and 3D Slicer and compared between various stages. Correlations between these changes, mandibular surgical movements and skeletal stability were further explored.
Most condyles at deviated side (DS) tended to shift inferiorly, anteriorly and to non-deviated side (NDS), while condyles at NDS were displaced posteriorly, inferiorly and laterally from T0 to T1. Condyles showed upward pitch, outward yaw and lateral roll at both sides. Bone resorption was more frequently observed in the posterior area of condylar surface at NDS. Significant correlations were found between mandibular anteroposterior/transverse stability and DS condylar lateral shift or NDS condylar yawing after surgery (T1-T2), respectively.
Our results comprehensively characterize 3D condylar changes and their associations with skeletal stability after surgical correction of Class III facial asymmetry.
These findings advance current understanding of complex condylar changes after bimaxillary orthognathic surgery in Class III facial asymmetry patients.
本研究旨在评估双颌正颌手术后III类面部不对称患者髁突的三维（3D）定量变化。
纳入2020年1月至2022年6月期间接受Le Fort I截骨术和双侧矢状劈开截骨术（BSSO）（有或无颏成形术）的55例符合条件的III类面部不对称患者。在术前1周（T0）、术后即刻（T1）和术后至少12个月（T2）这3个阶段收集每位患者的锥形束计算机断层扫描（CBCT）。使用ITK-SNAP和3D Slicer基于体素和表面配准测量髁突的位置变化和骨重塑，并在不同阶段之间进行比较。进一步探讨这些变化、下颌骨手术移动与骨骼稳定性之间的相关性。
从T0到T1，大多数偏斜侧（DS）的髁突倾向于向下、向前和向非偏斜侧（NDS）移位，而NDS的髁突向后、向下和向外移位。两侧髁突均表现出向上倾斜、向外偏航和侧向滚动。在NDS髁突表面后部更频繁地观察到骨吸收。分别在下颌骨前后/横向稳定性与术后（T1-T2）DS髁突侧向移位或NDS髁突偏航之间发现显著相关性。
我们的结果全面描述了III类面部不对称手术矫正后髁突的3D变化及其与骨骼稳定性的关系。
这些发现推进了目前对III类面部不对称患者双颌正颌手术后复杂髁突变化的理解。
