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Progressive condylar resorption after mandibular advancement.

Tadaharu Kobayashi1, Naoya Izumi, Taku Kojima

  • 1Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue, Regeneration and Reconstruction, Course for Oral Life Science, Niigata University Graduate, School of Medical and Dental Sciences, Niigata City 951-8514, Japan. tadaharu@dent.niigata-u.ac.jp

The British Journal of Oral & Maxillofacial Surgery
|March 29, 2011
PubMed
Summary

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Progressive condylar resorption after orthognathic surgery is linked to specific cephalometric and CT findings. Risk factors include mandibular rotation, retrognathism, condylar deformities, and surgical advancement, necessitating careful patient selection and postoperative care.

Area of Science:

  • Orthognathic Surgery
  • Temporomandibular Joint (TMJ) Disorders
  • Skeletal Relapse

Background:

  • Progressive condylar resorption (PCR) is an irreversible complication leading to late skeletal relapse post-orthognathic surgery.
  • Understanding risk factors is crucial for preventing PCR and improving surgical outcomes.

Observation:

  • Cephalometric analysis revealed clockwise mandibular rotation and retrognathism in patients with PCR.
  • Preoperative 3D CT scans showed condylar erosions or deformities in affected individuals.
  • Surgical factors included significant mandibular advancement and counterclockwise rotation of the mandibular proximal segment.

Findings:

  • Patients with specific preoperative cephalometric (e.g., small SNB angle, wide mandibular plane angle) and CT findings were at higher risk.

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  • Mean mandibular relapse was -6.4 mm, and posterior facial height relapse was -5.3 mm.
  • Temporomandibular joint symptoms like clicking and pain were observed pre- and postoperatively.
  • Implications:

    • Identifying high-risk patients preoperatively is essential for informed surgical planning.
    • Advancing the mandible should be considered only when condyles appear stable on radiographs.
    • Postoperative management should focus on minimizing mechanical loading on the temporomandibular joint in at-risk individuals.