Condylar positioning in orthognathic surgery
a cone beam computed tomography-based in vitro analysis of a positioning method
Aim: Orthognathic surgery aims to correct facial skeletal deformities and the correct condylar positioning is very important for stable results. The aim of the present study was to verify the occurrence of changes in the postoperative condylar positioning in artificial skulls with a skeletal Class II maxillomandibular relationship submitted to bilateral sagittal split osteotomy when the method of cephalometric data transfer was used. Methods: Ten skeletal Angle class II polyurethane skulls were used with metallic markers in the articular surfaces of the temporomandibular joint and mandibular condyles. The skulls were submitted to preoperative and postoperative cone beam computed tomography before and after the bilateral sagittal split osteotomy. To verify the condylar positioning, measurements between the distances of the markers at the temporal bones and mandibular condyles were taken in the coronal and sagittal views by the DISTANCE tool of the iCat Vision software. All measurements were obtained by one examiner in the preoperative and postoperative CBCTs, tabulated and submitted to statistical analysis by the Wilcoxon test with a level of significance of 5% (p<0,05). After 15 days of the completion of the first data collection, all measurements were redone to determine the random and systematic error by the Intraclass Correlation Coefficient. Results: With the exception of the average of the lateral-medial distance (from the measurements between the medium left markers only), the averages of the anterior-posterior distances (only in the left posterior and lateral right markers) and the vertical average (only in the central markers) showed no statistically significant differences between the preoperative and postoperative distances of the metallic markers. Conclusion: Even when using the method of cephalometric data transfer, variation of the condylar positioning occurred between the preoperative and postoperative periods. This variation occurred only in a few points of the mandibular condyles.
Gonçales ES, Duarte MAH, Palmieri Jr C, Zakhary GM, Ghali EG. Retrospective analysis of the effects of orthognathic surgery on the pharyngeal airway space. J Oral Maxillofac Surg. 2014 Nov;72(11):2227-40. doi: 10.1016/j.joms.2014.04.006.
Stricker M, Van der Meulen JC, Raphael B. Craniofacial malformation. Edinburg: Churchill-Livingstone; 1990.
Stricker M, Raphael B. Croissance cranio-faciale normale et pathologique: L’interception therapeutique et son devenir. Morfos: Reims; 1993.
Bell WH, Proffit WR, White RP. Surgical correction of dentofacial deformities. Philadelphia: Saunders; 1980.
Gonçales, AGB, Tieghi-Neto V, Gonçales ES, Capelozza ALA. Comparative dimensional tomographic study of the mandibular condyle of individuals with transverse maxillary deficiency. Braz J Oral Sci. 2017 Sep,15(4):242-7. doi: 10.20396/bjos.v15i4.8650028.
Politi M, Toro C, Costa F, Polini F, Robiony M. Intraoperative awakening of the patient during orthognathic surgery: a method to prevent the condylar sag. J Oral Maxillofac Surg. 2007 Jan;65(1):109-14.
Hiatt WR, Schelkun PM, Moore DL. Condylar positioning in orthognathic surgery. J Oral Maxillofac Surg. 1988 Dec;46(12):1110-2.
Raveh J, Vuillemin T, Ladrach K, Sutter F. New techniques for reproduction of the condyle relation and reduction of complications after sagittal ramus split osteotomy of the mandibule. J Oral Maxillofac Surg. 1988 Sep;46(9):751-7.
Leonard MS. Maintenance of condylar position after sagittal split osteotomy of the mandibule. J Oral Maxillofac Surg. 1985 May;43(5):391-2.
Rostkoff KS, Herbosa EG, Villa P. Maintenance of condyle-proximal segment position in orthognathic surgery. J Oral Maxillofac Surg. 1991 Jan;49(1):2-8.
Merten H, Halling F. A new condylar positioning technique in orthognathic surgery. Technical note. J Craniomaxillofac Surg. 1992 Oct;20(7):310-2..
Helm G, Stepke MT. Maintenance of the preoperative condyle position in orthognathic surgery. J Craniomaxillofac Surg. 1997 Feb;25(1):34-8.
Puricelli E. A new method for transfer of cephalometric data in the orthognathic surgery patients. J Oral Maxilofac Surg. 1997;26(Suppl):140.
Puricelli E. A new method for mandibular osteotomy. Head Face Med. 2007 Mar; 15-23. doi: 10.1186/1746-160X-3-15.
Bettega G, Cinquin P, Lebeau J, Raphaël B. Computer assisted ortghognathic surgery: clinical evaluation of mandibular condyle repositioning system. J Oral Maxillofac Surg. 2002 Jan;60(1):27-35.
Saka B, Petsch I, Hingst V, Härtel J. The influence of pre and intraoperative positioning of the condyle in the centre of the articular fossa on the position of the disc in orthognathic surgery. A magnetic resonance study. Br J Oral Maxillofac Surg. 2004 Apr;42(2):120-6.
Iwai T, Omura S, Honda K, Yamashita Y, Shibutani N, Fujita K, et al.. An accurate bimaxillary repositioning technique using straight locking miniplates for the mandible-first approach in bimaxillary orthognathic surgery. Odontology. 2017 Jan;105(1):122-126. doi: 10.1007/s10266-016-0236-7.
Polley JW, Figueroa A. Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery. J Oral Maxillofac Surg. 2013 May;71(5):911-20. doi: 10.1016/j.joms.2012.11.004.
Bettega G, Dessenne V. Computer-assisted mandibular condyle positioning in orthogna thic surgery. J Oral Maxillofac Surg. 1996 May;54(5):553-8.
Renzi G, Becelli R, Paolo C, Iannetti G. Indications to the use of condylar repositioning devices in the surgical treatment of dental-skeletal class III. J Oral Maxillofac Surg. 2003 Mar;61(3):304-9.
Ellis E. Condylar positioning for ortognathic surgery: are they necessary?. J Oral Maxillofac Surg. 1994 Jun;52(6):536-54.
Costa F, Robiony M, Toro C, Sembronio S, Polini F, Politi M. Condylar positioning devices for orthognathic surgery: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Aug;106(2):179-90. doi: 10.1016/j.tripleo.2007.11.027.
Perez DE, Liddell A. Controversies in orthognathic surgery. Oral Maxillofac Surg Clin North Am. 2017 Nov;29(4):425-440. doi: 10.1016/j.coms.2017.07.008.
Houston WJB. The analysis of errors in orthodontic measurements. Am J Orthod. 1983 May;83(5):382-90.
Fleiss JL. Analysis of data from multiclinic trials. Control Clin Trials. 1986 Dec;7(4):267-75.
Ueki K, Moroi A, Sotobori M, Marukawa M, Takatsuka S, Yoshizawa K et al. A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Nov;114(5):567-76. doi: 10.1016/j.oooo.2011.12.026.
Epker BN, Wylie GA. Control of the condylar-proximal mandibular segments after sagittal split osteotomies to advance the mandible. Oral Surg Oral Med Oral Pathol. 1986 Dec;62(6):613-7.
Luhr HG. The significance of condylar position using rigid fixation in orthognathic surgery. Clin Plast Surg. 1989 Jan;16(1):147-56.
Puricelli E, Fonseca JSO, Paris MF, Sant’Anna H. Applied mechanics of the puricelli osteotomy: a linear elastic analysis with the finite element method. Head Face Med. 2007 Nov;3:38-45.
Copyright (c) 2019 Brazilian Journal of Oral Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Brazilian Journal of Oral Sciences uses the Creative Commons license (CC), thus preserving the integrity of the articles in an open access environment.