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

Kita, Soma; Fujita, Kiyohide; Imai, Hisato; Aoyagi, Misaki; Shimazaki, K.; Yonemitsu, Ikuo; Omura, Susumu; Ono, Takashi

doi:10.1016/j.bjoms.2019.10.309

Cited by 14 publications

(12 citation statements)

References 22 publications

(39 reference statements)

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“…For example, Japanese patients tend to exhibit higher mandibular retrusion and labial inclination of the anterior teeth, steeper mandibular planes, and a greater tendency toward high angle facial types 6) . High angle facial types possess a shorter ramus height, which is more difficult to maintain during mandibular advancement, primarily because this height will most likely increase 8) . In contrast to low angle facial type cases, high angle facial types require a significant increase in ramus height.…”

Section: Orthognathic Surgical Methodsmentioning

confidence: 99%

Surgical Orthodontic Treatment in Case of Severe High Angle Skeletal Class II Malocclusion and Mandibular Retrusion

Tachiki

Yamamoto

Takaki

et al. 2020

Bull. Tokyo Dent. Coll.

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Section: Orthognathic Surgical Methodsmentioning

confidence: 99%

Surgical Orthodontic Treatment in Case of Severe High Angle Skeletal Class II Malocclusion and Mandibular Retrusion

Tachiki

Yamamoto

Takaki

et al. 2020

Bull. Tokyo Dent. Coll.

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“…Operative stress arising from osteotomy of the mandibular ramus and repositioning of the distal fragments of the mandible (e.g., the body of the mandible) may lead to postoperative development or exacerbation of progressive condylar resorption in patients with maxillary prognathism, VME, and significant deformation of the condyle [ 18 – 20 ]. Therefore, maxillary osteotomy alone (without mandibular osteotomy) is recommended to prevent relapse of the mandible [ 21 , 22 ]. The maxilla is repositioned posteriorly with impaction to improve the facial appearance and occlusion, whereas the mandible undergoes reactionary counter-clockwise rotation during postero-superior repositioning, to achieve occlusion with the maxilla ( Fig 1 ).…”

Section: Introductionmentioning

confidence: 99%

Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla

et al. 2022

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Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.

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“…19 Recently, a comparative study on the subject of skeletal stability 1 year after surgery considered between isolated Le Fort I osteotomy and conventional 2-jaw surgery in patients with similar amounts of forward movement of point B indicated that the former was more stable than the latter. 20 A few studies have evaluated condylar remodeling and resorption 17 or skeletal relapse [21][22][23] following isolated Le Fort I osteotomy. Here, the degree of skeletal relapse was compared between wire fixation and mini-plate fixation after isolated maxillary surgery or between bimaxillary surgery and isolated maxillary surgery in patients with different surgical movements at point B.…”

mentioning

confidence: 99%

“…Although the relationship between mandibular autorotation and maxillary impaction or positional changes of the mandibular condyle after mandibular autorotation have been covered, 17,[19][20][21][22][23][24][25] the positional changes of displaced condyles following isolated Le Fort I osteotomy have not been widely discussed. Moreover, there is no report detailing the correlation between condylar displacement and the surgical movement inherent in mandibular autorotation for isolated maxillary surgery in patients with risk factors for pICR.…”

mentioning

confidence: 99%

Long-term Stability Over 2 Years After Isolated Maxillary Orthognathic Surgery Combined With Mandibular Autorotation in Risk Patients for Condylar Resorption

Xiong

Yang

Kim

et al. 2023

Journal of Craniofacial Surgery

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Objective: Counterclockwise rotation of mandible can cause condylar resorption and condylar displacement posteroinferiorly after maxillary orthognathic surgery with mandibular in patients with high-angle mandibular retrognathism. This study was aimed to evaluate long-term stability >2 years and postoperative changes of condylar displacement. Materials and methods: In 15 patients who underwent Le Fort I osteotomy with mandibular autorotation, postoperative stability was cephalometrically investigated until 2 years. Condylar changes were analyzed with transcranial temporomandibular joint projection. Correlation between condylar displacement and surgical movement was analyzed. Results: Significant clockwise relapse of mandible (P<0.01 for SNB reduction and backward movement of point B) was observed between 6 months and >2 years after surgery, even though the values were small (0.5±0.1 degrees and 1.14±0.13 mm, respectively). The condyle was displaced posteroinferiorly immediately after surgery; however, it achieved a stable position at postoperative 6 weeks. The amount of vertical condylar displacement was significantly correlated with surgical change in mandibular posterior border sagittal angle, palatal plane angle, facial height ratio, and point B in the horizontal dimension. Greater mandibular rotation prompted more vertical condylar displacement. Conclusions: Small mandibular relapse in long term should be considered after maxillary orthognathic surgery with mandibular autorotation, although it is regarded as a surgical maneuver to minimize mandibular instability in patients susceptible to postoperative condylar resorption.

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

Cited by 14 publications

References 22 publications

Surgical Orthodontic Treatment in Case of Severe High Angle Skeletal Class II Malocclusion and Mandibular Retrusion

Surgical Orthodontic Treatment in Case of Severe High Angle Skeletal Class II Malocclusion and Mandibular Retrusion

Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla

Long-term Stability Over 2 Years After Isolated Maxillary Orthognathic Surgery Combined With Mandibular Autorotation in Risk Patients for Condylar Resorption

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