Will L A, Joondeph D R, Hohl T H, West R A
J Oral Maxillofac Surg. 1984 Sep;42(9):578-88. doi: 10.1016/0278-2391(84)90088-0.
Forty-one patients who elected to receive a bilateral sagittal osteotomy to advance the mandible were examined clinically and radiographically to assess condylar position preoperatively and at three specific times postoperatively. Parameters designed to measure changes in condylar and distal fragment position were located on tracings and digitized for statistical analysis. Changes in distal fragment position included advancement and clockwise rotation during the surgical interval and significant posterior relapse with continued clockwise rotation during the period of maxillomandibular fixation. A small amount of counterclockwise rotation associated with interocclusal splint removal was seen following fixation release. No significant condylar movement was seen during the surgical interval. During the period of maxillomandibular fixation, both condyles exhibited a significant superior movement, and the left condyle also moved posteriorly. No changes in condylar position were noted following release of fixation. The clinical significance of these condylar movements is not clear. Despite minimal changes, 18 patients, six of whom had had no preoperative symptoms and one of whom had exhibited reciprocal clicking, complained of temporomandibular joint pain or noise postoperatively. This suggests that maintenance of condylar position during surgery may not prevent temporomandibular joint dysfunction. In addition, the observed 37% relapse in surgical advancement in the absence of significant condylar distraction implies the interaction of other factors in the relapse process.
对41例选择接受双侧矢状劈开截骨术前移下颌骨的患者进行了临床和影像学检查，以评估术前及术后三个特定时间点的髁突位置。用于测量髁突和远心骨段位置变化的参数标在描图上并数字化以便进行统计分析。远心骨段位置的变化包括手术期间的前移和顺时针旋转，以及在颌间固定期间显著的向后复发并伴有持续的顺时针旋转。固定解除后，可见与咬合板去除相关的少量逆时针旋转。手术期间未见髁突有明显移动。在颌间固定期间，双侧髁突均出现明显的向上移动，左侧髁突还向后移动。固定解除后，髁突位置未见变化。这些髁突移动的临床意义尚不清楚。尽管变化极小，但18例患者术后出现颞下颌关节疼痛或弹响，其中6例术前无任何症状，1例术前有交互性弹响。这表明手术过程中维持髁突位置可能无法预防颞下颌关节功能障碍。此外，在无明显髁突移位的情况下，观察到手术前移有37%的复发，这意味着在复发过程中有其他因素相互作用。
