Positional changes of the mandibular condyle in unilateral sagittal split ramus osteotomy combined with intraoral vertical ramus osteotomy for asymmetric class III malocclusion

In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

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Osteossíntese no Tratamento Cirúrgico dos Prognatismos: Estado da Arte

Acta Médica Portuguesa ◽

10.20344/amp.7788 ◽

2017 ◽

Vol 30 (3) ◽

pp. 224

Author(s):

Nuno Durão ◽

José Amarante

Keyword(s):

Relevant Literature ◽

Inferior Alveolar Nerve ◽

Class Iii ◽

Class Iii Malocclusion ◽

Sagittal Split Ramus Osteotomy ◽

Acceptable Alternative ◽

Mandibular Setback ◽

Common Technique ◽

The Stability

Introduction: Prognathism is a common skeletal facial abnormality, associated with class III malocclusion, often with repercussions in quality of life. In addition to orthodontic treatment, sagittal split ramus osteotomy is the most common technique for its correction, and segment osteosynthesis is an important element of the post-surgical outcome.Materials and Methods: A search for relevant literature was conducted in the PubMed/MEDLINE database and in other relevant sources.Results: The stability of different fixation methods, their repercussions on inferior alveolar nerve lesions, and the type of material are among the most researched subjects.Discussion: Recent research about the type of osteosynthesis applied in the sagittal split ramus osteotomy for mandibular setback is discussed.Conclusion: Miniplates appear to be the better option for fixation of sagittal split osteotomy for mandibular setback. Bioabsorbable osteosynthesis may be an acceptable alternative to titanium.

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Predisposing Conditions for Condylar Luxation After Intraoral Vertical Ramus Osteotomy

10.21203/rs.3.rs-132750/v1 ◽

2021 ◽

Author(s):

Satoshi Rokutanda ◽

Shin-Ichi Yamada ◽

Souichi Yanamoto ◽

Hiroshi Sakamoto ◽

Keisuke Omori ◽

...

Keyword(s):

Temporomandibular Disorders ◽

Operating Characteristic ◽

Characteristic Curve ◽

Univariate Analysis ◽

Mandibular Condyle ◽

Downward Movement ◽

Worst Case ◽

Intraoral Vertical Ramus Osteotomy ◽

Operating Characteristic Curve ◽

Vertical Ramus Osteotomy

Abstract Intraoral vertical ramus osteotomy (IVRO) is a surgical procedure for the treatment of mandibular prognathism and temporomandibular disorders. However, the improvement of temporomandibular disorders after surgery is considered to be due to the anterior and downward movement of the mandibular condyle, which may lead to condylar sag, and in the worst case, condylar luxation. In this retrospective cohort study, we examined factors potentially associated with condylar luxation. Univariate analysis indicated that condylar luxation was significantly associated with the following factors: magnitude of setback (P = 0.001); presence of temporomandibular joint (TMJ) symptoms (P = 0.002); occlusal cant correction ≥ 2 mm (P = 0.018); and mandibular condyle deformation (P < 0.001). The magnitude of setback (P = 0.035) and the presence of TMJ symptoms (P = 0.008) remained significant in the multivariate analysis. In the receiver operating characteristic curve, the cut-off value of the magnitude of setback for condylar sag and condylar luxation after IVRO was 3.25 mm. Thus, the risk of condylar luxation after IVRO is increased with a smaller magnitude of setback (≤ 3.25 mm) and the presence of TMJ symptoms. These factors should be carefully evaluated by surgeons during treatment planning for IVRO.

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