The role of mandibular proximal segment rotations on skeletal relapse and condylar remodelling following bilateral sagittal split advancement osteotomies

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• 作者：Tong Xi^a ; ^{Tong.Xi@radboudumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Martien de Koning^a ; ^{Martien.deKoning@radboudumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Stefaan Bergé ; ^a ; ^{Stefaan.Berge@radboudumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Theo Hoppenreijs^b ; ^{thoppenreijs@rijnstate.nl" class="auth_mail" title="E-mail the corresponding author} ; Thomas Maal^a ; ^{Thomas.Maal@radboudumc.nl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：3D ; Bilateral sagittal split osteotomy ; CBCT ; Condylar remodelling ; Proximal segment ; Relapse
• 刊名：Journal of Cranio-Maxillofacial Surgery
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：43
• 期：9
• 页码：1716-1722
• 全文大小：549 K

文摘

To quantify the postoperative rotation of the proximal segments in 3D and to assess its role on skeletal relapse and condylar remodelling following BSSO advancement surgery.

Material and methods

56 patients with mandibular hypoplasia who underwent BSSO advancement surgery were enrolled into the study. A CBCT scan was acquired preoperatively, at one week postoperatively and at one year postoperatively. After segmentation of the facial skeleton and condyles, 3D cephalometry and condylar volume analysis were performed.

Results

A mean mandibular advancement of 4.6 mm was found. 55% of the condyles decreased in volume postoperatively, with a mean reduction of 6.1 volume-percent. Among 11 patients who exhibited a clinically significant relapse of more than 2 mm, 10 patients exhibited a counterclockwise rotation of the proximal segments. The odds of skeletal relapse (>2 mm) was 4.8 times higher in patients whose proximal segments were rotated in a counterclockwise direction. Postoperative flaring (3.3 mm) and torque (0.3°) were, however, not associated with skeletal relapse or condylar remodelling.

Conclusion

Gender, preoperative condylar volume, postoperative condylar remodelling, counterclockwise rotation of the proximal segment and the amount of surgical advancement were prognostic factors for skeletal relapse (r² = 0.83). The role of the mandibular plane angle in relapse is questionable.