Hoppenreijs T J, Freihofer H P, Stoelinga P J, Tuinzing D B, van't Hof M A
Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, The Netherlands.
Int J Oral Maxillofac Surg. 1998 Apr;27(2):81-91. doi: 10.1016/s0901-5027(98)80301-9.
A sample of 259 patients with vertical maxillary hyperplasia, mandibular hypoplasia and anterior vertical open bite, collected from three different institutions, was analysed regarding temporomandibular joint (TMJ) sounds, condylar remodelling, and condylar resorption. All patients underwent Le Fort I osteotomies, and bilateral sagittal split advancement osteotomies were performed in 117 patients. Intraosseous wire fixation was used in 149 and rigid internal fixation in 110 patients. Cephalometric and orthopantomographic radiographs were available before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). The number of patients with TMJ sounds decreased from 38% to 31%. At the latest follow up 23.6% of the patients showed condylar remodelling, 7.7% unilateral condylar resorption and 7.7% bilateral condylar resorption. Condylar contours, as assessed on orthopantomographic radiographs, were classified as five different types. Condyles with preexisting radiological signs of osteoarthrosis or having a posterior inclination were at high risk for progressive resorption. Female patients with severe anterior open bite, high mandibular plane angle and a low posterior-to-anterior facial height ratio, who underwent a bimaxillary osteotomy, were prone to condylar resorption. Bone loss was predominantly found at the anterior site of the condyle. The incidence of condylar resorption was significantly higher after bimaxillary osteotomies (23%) than after only Le Fort I intrusion osteotomies (9%). Avoidance of intermaxillary fixation by using rigid internal fixation tended to reduce condylar changes, in particular in patients who underwent only a Le Fort I osteotomy. Rigid internal fixation in bimaxillary osteotomies resulted in condylar remodelling in 30% and progressive condylar resorption in 19% of the patients. Condylar changes were not significantly different after using either miniplate osteosynthesis or positional screws in bilateral sagittal split osteotomy procedures.
对从三个不同机构收集的259例垂直上颌骨增生、下颌骨发育不全和前牙垂直开合患者的样本，就颞下颌关节（TMJ）弹响、髁突重塑和髁突吸收情况进行了分析。所有患者均接受了Le Fort I型截骨术，117例患者进行了双侧矢状劈开前徙截骨术。149例患者采用骨内钢丝固定，110例患者采用坚固内固定。术前、术后即刻、术后一年及最新随访时均有头颅侧位片和曲面断层片。平均随访时间为69个月（范围20 - 210个月）。有TMJ弹响的患者数量从38%降至31%。在最新随访时，23.6%的患者出现髁突重塑，7.7%出现单侧髁突吸收，7.7%出现双侧髁突吸收。根据曲面断层片评估，髁突轮廓分为五种不同类型。术前存在骨关节炎放射学征象或有后倾的髁突发生进行性吸收的风险较高。接受双颌截骨术的严重前牙开合、高下颌平面角和低后前面部高度比的女性患者容易发生髁突吸收。骨质丢失主要发生在髁突前部。双颌截骨术后髁突吸收的发生率（23%）显著高于仅行Le Fort I型上移截骨术（9%）。采用坚固内固定避免颌间固定倾向于减少髁突变化，尤其是仅接受Le Fort I型截骨术的患者。双颌截骨术中采用坚固内固定，30%的患者出现髁突重塑，19%的患者出现进行性髁突吸收。在双侧矢状劈开截骨术中使用微型钢板内固定或定位螺钉后，髁突变化无显著差异。
