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Proximal segment positioning in bilateral sagittal split osteotomy: intraoperative controlled positioning by a
Constantin A Landes1, Marcus Sterz
1Maxillofacial and Plastic Facial Surgery, J.W. Goethe University Medical Center, Frankfurt, Germany. c.landes@lycos.com
Summary
This study optimized condylar position in osteotomy patients using a novel splint, significantly reducing postoperative dysfunction and skeletal relapse. The technique improved temporomandibular joint outcomes over 24 months.
Area of Science:
- Orthognathic surgery
- Temporomandibular joint (TMJ) biomechanics
- Maxillofacial reconstruction
Background:
- Conventional proximal segment positioning techniques often impede intraoperative condyle displacement.
- Optimizing the preoperative condyle-disc-fossa relationship is crucial for surgical success.
- Existing methods may not fully address the dynamic nature of condylar positioning during bimaxillary osteotomies.
Purpose of the Study:
- To optimize condylar position in patients undergoing bimaxillary osteotomy.
- To evaluate the efficacy of a novel positioning splint in achieving desired condylar placement.
- To assess the impact of optimized condylar positioning on postoperative TMJ function and skeletal stability.
Main Methods:
- A study group of 23 bimaxillary operated patients utilized a positioning splint and plates for intraoperative joint positioning.
- Positioning splints were custom-fabricated based on preoperative sonograms and MRI assessments.
- A control group of 18 patients received conventional plate positioning based on habitual occlusion.
- Clinical follow-up, axiography, and sonography were conducted for 24 months.
Main Results:
- The study group demonstrated significantly reduced postoperative temporomandibular joint dysfunction compared to controls (P <.021).
- Lower prevalence of disc dislocation (P <.07) and smaller postoperative changes in condylar translation (P <.014) were observed in the study group.
- Skeletal relapse incidence was notably lower in the study group (8%) compared to the control group (22%).
Conclusions:
- A proximal segment-positioning splint effectively guided condyle placement in the intended direction.
- The technique significantly decreased postoperative dysfunction, disc dislocations, and condylar translation changes.
- Despite some relapse, the optimized positioning splint showed a reduced incidence of skeletal relapse at 24-month follow-up.