Intraoperative condylar positioning techniques on mandible in orthognathic surgery

Abstract

Purpose The surgical condylar displacement often resulted in relapse and serious symptoms of temporomandibular joint disorders (TMD) after orthognathic surgery. To minimize the displacement, numerous techniques have been proposed. To verify their accuracy in positioning and effectiveness in preventing post‐operative TMD and relapse, we reviewed the literature related to intraoperative condylar positioning techniques on the mandible in this study. Methods The literature on condylar positioning techniques was reviewed with two charts, including the non‐computer‐assisted and the computer‐assisted positioning methods. The pre‐ and post‐operative alterations of condyles, the post‐operative temporomandibular joint (TMJ) function and surgical relapse were analysed regarding the techniques. The clinical usage and characteristics were reviewed as well. Results A total of 22 articles, including 907 patients, have been reported since 2001. Nearly all methods reach a considerable positioning accuracy within the range of 1‐2 mm and 1‐2° from the pre‐operative position. We ranked the accuracy of the methods from high to low: CAD/CAM CPDs > CAD/CAM titanium plate positioning > manual positioning > computer‐assisted navigation systems > imaging positioning systems. Most skeletal class II and class III patients achieved great occlusion and had no TMJ dysfunction or relapse after condylar positioning. Conclusions Both the non‐computer‐assisted and computer‐assisted condylar positioning techniques reach considerable accuracy in locating the pre‐operative condyle position and preventing TMJ dysfunction and surgical relapse. Different levels of surgeons and cases can benefit from multiple suggested positioning methods. Further research with large samples and long‐term follow‐up is worth looking forward to upgrading the current methods, improving the clinical utility and developing new positioning techniques.

Causes of Reoperation Consultation and Clinical Review of Actual Reoperation After Previous Orthognathic Surgery

“…By combining 3D virtual simulation and CAD/CAM technologies, it becomes possible for maintaining the condylar position of the proximal segment as much as possible and forming an osteotomy line ideal for the surgical plan. In addition, more accurate and predictable condylar positioning is possible with a prefabricated plate made from virtual surgery 26 …”

“…In addition, more accurate and predictable condylar positioning is possible with a prefabricated plate made from virtual surgery. 26 Orthognathic surgery has been established as one of the common surgical treatments for dentofacial deformity. In addition, owing to advances in imaging and computer technology, it is possible to minimize intraoperative and postoperative complications of OGS.…”

Concordance among three diagnostic methods for determining the position of the mandibular condyle

“…It has been suggested that the condylar position may be related to dysfunctions of the gnathic system [1]. The condylar position may have a dramatic effect on the position of the mandibular body, which, in turn, may significantly affect the diagnosis and treatment in diverse areas of dentistry [2].…”

Evaluation of the Mandibular Condyle Morphologic Relation before and after Orthognathic Surgery in Class II and III Malocclusion Patients Using Cone Beam Computed Tomography

“…Individuals having bimaxillary orthognathic surgery may have a relapse and temporomandibular dysfunction as postoperative consequences [ 10 ]. Following orthognathic surgery, postoperative condylar movement may often produce recurrence or severe symptoms of temporomandibular joint disorders, therefore, various methods have been presented to reduce the dislocation, among them digital ones, or manual adjusting [ 11 ].…”