下颌后缩伴颞下颌关节重度骨关节病患者正颌术后颌骨稳定性及髁突体积变化的评价

doi:10.19723/j.issn.1671-167X.2020.01.018

Abstract

Abstract:

Objective: To investigate the effect of preoperative condylar condition for mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis on the stability of the jaw after orthognathic surgery and on the postoperative condylar volume changes. Methods: In this retrospective study, from 2014 to 2019, 37 patients including 1 male and 36 female, aged between 21 to 34 years old with an average age of (28.03±6.52) years, were diagnosed with mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis by Peking University School and Hospital of Stomatology and received orthognathic surgery, meeting the inclusion criteria were included. According to the preoperative condylar condition. There were divided into smooth group and non-smooth group, the lateral cephalometric films 1 week (T0), 3 months (T1), 6 months (T2) and 1 year (T3) after surgery were used to establish the coordinate system and cephalometric analysis to determine the stability of the jaw after operation. The three-dimensional model of the condyle was segmented by cone beam computed tomography (CBCT) 1 week (T0), 3 months (T1), 6 months (T2) and 1 year (T3) after surgery and the volume was obtained to evaluate the change of the condyle volume after surgery. CBCT image data was used to evaluate the changes of the condylar condition after surgery, and to clarify the correlation between the postoperative condylar condition and jaw stability. SPSS 20.0 statistical software was used for statistical analysis, Fisher’s exact probability methods were used to compare whether there were statistically significant differences in the stability of the mandibular joint at stages T1, T2 and T3 with different preoperative condylar condition.Spearman correlation coefficient analysis and Mann-Whitney test were used to compare whether there were statistically significant differences in the volume changes at stages T1, T2 and T3 after surgery between the two groups. Results: The recurrence rates of the mandible in the condylar smooth group were T1 36.85%, T2 47.37% and T3 42.11%, respectively. The recurrence rates in the non-smooth condylar group were T1 27.78%, T2 44.44% and T3 55.56%, respectively. There was no statistical difference in the recurrence rates between the two groups at different time points. There was no significant difference in the condylar volume change between smooth group and non-smooth group. Conclusion: For patients with mandible retrognathism deformities with severe temporomandibular joint osteoarthrosis and no significant changes in the condyle observed for one year before surgery, there is no difference in the influence of the preoperative condylar condition on the stability of jaw after operation, and no definite influence on the volume of the condyle after operation. Condylar resorption 3 months after surgery can cause instability of the jaw after orthognathic surgery.

Key words: Severe osteoarthrosis, Retrognathia, Orthognathic surgery, Relapse

CLC Number:

R782

Lei HOU,Guo-hua YE,Xiao-jing LIU,Zi-li LI. Evaluation of mandibular stability and condylar volume after orthognathic surgery in patients with severe temporomandibular joint osteoarthrosis[J].Journal of Peking University(Health Sciences), 2020, 52(1): 113-118.

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References 30

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Landmark	Definition
S	Geometric center of pituitary fossa
N	Most anterior point on fronto-nasal suture
A	The most posterior point in the concavity between ANS and prosthion
B	The most posterior midline point in the concavity of the mandible between the most superior point on the alveolar bone overlying the mandibular incisors (infradentale) and Pg
Pg	The most anterior point on the symphysis
Ar	The intersection of the lower margin of the skull base and the posterior margin of the mandibular condyle neck

Measurement items	Definition
SNA	The angle formed by point S, point N and point A
SNB	The angle formed by point S, point N and point B
MP-SN	The angle of intersection of the MP plane and the SN plane
B-x	The forward and backward distance of point B
B-y	The vertical distance of point B
Pg-x	The forward and backward distance of point Pg
Pg-y	The vertical distance of point Pg

Group	T1			T2			T3
Group	Stable	Unstable	P	Stable	Unstable	P	Stable	Unstable	P
Smooth	63.15% (12/19)	36.85% (7/19)	0.73	52.63% (10/19)	47.37% (9/19)	1.00	57.89% (11/19)	42.11% (8/19)	0.57
Non-smooth	72.22% (13/18)	27.78% (5/18)		55.56% (10/18)	44.44% (8/18)		44.44% (8/18)	55.56% (10/18)

Group		Smooth	Non-smooth	P
Left condylar	T1	0.00(-8.00, 8.00)	5.00 (-0.75, 10.00)	0.12
	T2	3.00 (-4.00, 14.00)	10.00 (-1.00, 13.25)	0.36
	T3	9.00 (4.00, 17.00)	12.00 (-0.75, 16.25)	0.96
Right Condylar	T1	-2.00 (-5.00, 10.00)	1.00 (-2.05, 5.75)	0.65
	T2	6.00 (-4.00, 19.00)	2.00 (-3.75, 6.00)	0.09
	T3	1.00 (1.00, 19.00)	8.50 (-0.25, 21.00)	0.64

Group		T1			T2					T3
Group		Stable	Unstable	P	Stable	Unstable		P		Stable	Unstable	P
Smooth	Condylar Stable	8	3	1.00	5	5	0.64		6		7	1.00
Smooth	Condylar progress	5	2		5	3			2		3
Non smooth	Condylar Stable	11	3	0.03	3	7	0.07		7		4	0.65
Non smooth	Condylar progress	1	4		7	2			4		4

Evaluation of mandibular stability and condylar volume after orthognathic surgery in patients with severe temporomandibular joint osteoarthrosis

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