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Does Condylar Morphology Affect Maxillary Repositioning in Bimaxillary Orthognathic Surgery?
Namiaki Takahara1, Nobuyoshi Tomomatsu, Hirokazu Kachi
1Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
The Journal of Craniofacial Surgery
|May 16, 2024
Summary
Condylar morphology significantly impacts maxillary repositioning accuracy in bimaxillary surgery. Abnormal temporomandibular joint (TMJ) morphology is linked to greater maxillary misalignment, particularly in skeletal Class II malocclusion patients.
Area of Science:
- Orthognathic surgery
- Temporomandibular joint (TMJ) morphology
- Maxillofacial reconstruction
Background:
- Bimaxillary surgery aims to correct severe skeletal discrepancies.
- Mandibular-dependent splints are used to guide maxillary repositioning.
- The influence of temporomandibular joint (TMJ) morphology on surgical outcomes requires further investigation.
Purpose of the Study:
- To assess the association between condylar morphology and maxillary centroid repositioning accuracy after bimaxillary surgery.
- To identify factors influencing maxillary repositioning errors in patients with skeletal malocclusions.
Main Methods:
- Computed tomography (CT) scans were used to characterize TMJ morphology (normal vs. abnormal).
- Computer-aided design/computer-aided manufacturing (CAD/CAM) splints guided Le Fort I osteotomy for maxillary repositioning.
- Maxillary centroid discrepancies were calculated by superimposing pre- and post-operative CT scans.
Main Results:
- Patients with abnormal TMJ morphology exhibited significantly greater average maxillary misalignment (1.53 mm) compared to those with normal TMJ morphology (1.04 mm).
- A strong correlation was found between maxillary centroid discrepancies and the degree of dentofacial deformity.
- Skeletal Class II malocclusion patients showed a higher tendency for maxillary malposition.
Conclusions:
- Condylar morphology is a significant prognostic factor for maxillary repositioning errors in bimaxillary surgery utilizing mandibular-dependent splints.
- Abnormal TMJ morphology increases the risk of inaccuracies in maxillary repositioning.
- These findings highlight the importance of evaluating TMJ status in surgical planning for orthognathic procedures.
