Condylar Resorption After Orthognathic Surgery: A Systematic Review

Abstract

SUMMARY:The aim of this research was to evaluate the risk factors related to condylar resorption (CR) after orthognathic surgery. Was realized a systematic review with a search of the literature performed in the electronic databases PubMed, MedLine, Ovid, Cochrane Library for current evidence in the world literature as conducted, and relevant articles were selected in according to inclusion and exclusion criteria and the findings were compared. Eight papers, (follow-up 12 months to 69 months) were including. A sample of 2567 patient with mandible or bi maxillary surgery with an age range from 14 to 46 year old was observed. In 137 patients (5.3%) CR was observed , with a 97.6% (122) female. CR was related to 118 cases with mandibular deficiencies with high mandibular plane (advancement surgery). CR were present principally in bi maxillary surgery with a 103 cases (75.2%) and only two papers show any analysis to the relation with TMJ dysfunction. Current evidence in CR is poor but supports those female patients with mandibular deficiency and high mandibular plane angle submitted to bi maxillary surgery with change in occlusal plane (counterclockwise) are associated with condylar resorption after orthognathic surgery.

Short lingual osteotomy without fixation: a new strategy for mandibular osteotomy known as “physiological positioning”

“…The skeletal and dental stabilities after SLO in this study were equal to those after IVRO in our previous report. 9 The proximal segment temporarily swung posteriorly after surgery. This phenomenon was believed to be due to the anterior movement of the condylar process by the traction force of the mandibular ligaments and the external pterygoid muscles.…”

“…9 We believed that this strategy could be adapted not only for IVRO but also for SSRO. The postoperative management was performed as shown in Figure 1.…”

“…We have already reported on the postoperative stability with this approach. 9 However, there are some reports of maxillary artery injury during the IVRO operation because it is basically 3 blind surgery, which may cause life-threatening complications. 10,11 Almost 90% of the artery runs just inside the mandible ramus outside the lateral pterygoid muscle in Japanese people, whereas more than 45% of the artery runs inside the pterygoid muscle in Westerners.…”

Postoperative stability of conventional bimaxillary surgery compared with maxillary impaction surgery with mandibular autorotation for patients with skeletal class II retrognathia

“…to reduced posterior facial height, clockwise mandibular rotation, mandibular retrognathism, and anterior open bite. [3][4][5][6] Previous investigators assumed that atrophy resulted from resorption as a result of increased muscle tension of the geniohyoid and the anterior digastric muscles. 4,7 However, condylar resorption associated with BSSO is affected by several factors, including female sex, young age (15-35 years), mandibular hypoplasia with a high angle of the mandibular plane, preoperative dysfunction of the TMJ, posterior inclination of the condylar neck, large mandibular advancement, counter-clockwise rotation of the proximal segments of the mandible, increased muscle tension of the geniohyoid and anterior digastric muscles, and type of fixation.…”

“…[3][4][5][6] Previous investigators assumed that atrophy resulted from resorption as a result of increased muscle tension of the geniohyoid and the anterior digastric muscles. 4,7 However, condylar resorption associated with BSSO is affected by several factors, including female sex, young age (15-35 years), mandibular hypoplasia with a high angle of the mandibular plane, preoperative dysfunction of the TMJ, posterior inclination of the condylar neck, large mandibular advancement, counter-clockwise rotation of the proximal segments of the mandible, increased muscle tension of the geniohyoid and anterior digastric muscles, and type of fixation. 2,[4][5][6][8][9][10][11][12] Surgical factors associated with relapse (such as mandibular advancement, counter-clockwise rotation of the proximal segments of the mandible, increased tension in the geniohyoid and the anterior digastric muscles, and type of fixation) may be avoided if BSSO is not done.…”