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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 57-65. doi: 10.19723/j.issn.1671-167X.2024.01.010

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Mandibular condyle localization in orthognathic surgery based on mandibular movement trajectory and its preliminary accuracy verification

Xinyu XU,Ling WU,Fengqi SONG,Zili LI,Yi ZHANG,Xiaojing LIU*()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2023-10-05 Online:2024-02-18 Published:2024-02-06
  • Contact: Xiaojing LIU E-mail:user_nancy@163.com
  • Supported by:
    the Capital's Funds for Health Improvement and Research(首发2022-1-4101);the Fundamental Research Funds for the Central Universities(PKU2023XGK013);the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-21A05)

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Abstract:

Objective: To establish and assess the precision of pre-surgical condyle position planning using mandibular movement trajectory data for orthognathic surgery. Methods: Skull data from large-field cone beam computed tomography (CBCT) and dental oral scan data were imported into IVSPlan 1.0.25 software for 3D reconstruction and fusion, creating 3D models of the maxilla and mandible. Trajectory data of mandibular movement were collected using a mandibular motion recorder, and the data were integrated with the jaw models within the software. Subsequently, three-dimensional trajectories of the condyle were obtained through matrix transformations, rendering them visually accessible. A senior oral and maxillofacial surgeon with experience in both diagnosis and treatment of temporomandibular joint disease and orthognathic surgery selected the appropriate condyle position using the condyle movement trajectory interface. During surgical design, the mobile mandibular proximal segment was positioned accordingly. Routine orthognathic surgical planning was completed by determining the location of the mandibular distal segment, which was based on occlusal relationships with maxilla and facial aesthetics. A virtual mandible model was created by integrating data from the proximal and distal segment bone. Subsequently, a solid model was generated through rapid prototyping. The titanium plate was pre-shaped on the mandibular model, and the screw hole positions were determined to design a condylar positioning guide device. In accordance with the surgical plan, orthognathic surgery was performed, involving mandibular bilateral sagittal split ramus osteotomy (SSRO). The distal segment of the mandible was correctly aligned intermaxillary, while the proximal bone segment was positioned using the condylar positioning guide device and the pre-shaped titanium plate. The accuracy of this procedure was assessed in a study involving 10 patients with skeletal class Ⅱ malocclusion. Preoperative condyle location planning and intraoperative positioning were executed using the aforementioned techniques. CBCT data were collected both before the surgery and 2 weeks after the procedure, and the root mean square (RMS) distance between the preope-rative design position and the actual postoperative condyle position was analyzed. Results: The RMS of the condyle surface distance measured was (1.59±0.36) mm (95%CI: 1.35-1.70 mm). This value was found to be significantly less than 2 mm threshold recommended by the expert consensus (P < 0.05). Conclusion: The mandibular trajectory may play a guiding role in determining the position of the mandibular proximal segment including the condyle in the orthognathic surgery. Through the use of a condylar positioning guide device and pre-shaped titanium plates, the condyle positioning can be personalized and customized with clinically acceptable accuracy.

Key words: Orthognathic surgical procedures, Mandibular condyle, Mandibular movement, Computer-aided design

CLC Number: 

  • R782.2

Figure 1

Mandibular movement recording equipment and accessories A, maxillary locator with silicone rubber; B, maxillary locator-upper dentition model; C, schematic diagram of mandibular movement recorder usage."

Figure 2

Visualization of mandibular movement ① skull model; ② dentition model; ③ jaw segmentation and data registration; ④ patient-specific digital skull model; ⑤ maxillary locator-upper dentition model; ⑥ the registration of mandibular movement data with skull information; ⑦ schematic diagram of importation of mandibular movement data; ⑧ simulation of mandibular movement."

Figure 3

Virtual orthognathic surgical planning based on mandibular movement data ① selection of the target condyle location; ② initiation of surgical design commencing from the target condyle location (pink); ③ establishment of the positioning for all bone segments."

Figure 4

Condylar positioning guide design ① shape and secure titanium plates on the 3D mandibular model with titanium screws; ② use CBCT to identify screw hole positions after plate and screws removal; ③ register screw positions in the original mandibular 3D model; ④ design the guide device based on the screw hole positions."

Figure 5

Application process of the condylar positioning guide A, place the condylar positioning guide onto the mandible; B, the device identifies the vacant pin position; C, punching procedure."

Figure 6

Fixation of proximal and distal bone segments A, identify the location of the vertical osteotomy line; B, secure the pre-shaped titanium plate."

Figure 7

Registration based on non-surgical regions A, coronal section; B, axial section; C, sagittal section; D, 3D image overview (blue: preoperative designed skull model; red: actual postoperative skull model)."

Figure 8

Segmentation of the condyle model A, coronal section; B, axial section; C, sagittal section; D, 3D image overview."

Figure 9

Average distance measurements on the condylar surface A, preoperative design (blue) and postoperative (gray) condylar position; B, three-dimensional chromatogram of the right condyle; C, three-dimensional chromatogram of the left condyle. The root mean square values were low in the green region and high in the red and blue regions."

Table 1

The RMS distance between the preoperative design position and the actual postoperative condyle position"

Case no. RMS/mm
Right condyle Left condyle
1 1.54 1.78
2 1.40 2.83
3 1.62 1.63
4 1.71 1.41
5 1.68 1.63
6 1.43 1.52
7 0.97 1.54
8 1.43 1.27
9 1.84 1.74
10 1.64 1.23
1 Apostolakis D , Michelinakis G , Kamposiora P , et al. The current state of computer assisted orthognathic surgery: A narrative review[J]. J Dent, 2022, 119, 104052.
doi: 10.1016/j.jdent.2022.104052
2 Ho CT , Lin HH , Liou EJ , et al. Three-dimensional surgical simulation improves the planning for correction of facial prognathism and asymmetry: A qualitative and quantitative study[J]. Sci Rep, 2017, 7, 40423.
doi: 10.1038/srep40423
3 黄俊强, 黄臻, 伍军, 等. 骨性Ⅲ类错牙合伴下颌偏斜患者下颌支矢状劈开截骨术前后髁突位置的锥形束CT分析[J]. 中华口腔医学杂志, 2019, 54 (10): 649- 655.
4 Nunes de Lima V , Faverani LP , Santiago JF Jr , et al. Evaluation of condylar resorption rates after orthognathic surgery in class Ⅱ and Ⅲ dentofacial deformities: A systematic review[J]. J Craniomaxillofac Surg, 2018, 46 (4): 668- 673.
doi: 10.1016/j.jcms.2018.02.002
5 Pachnicz D , Ramos A . Mandibular condyle displacements after orthognathic surgery: An overview of quantitative studies[J]. Quant Imag Med Surg, 2021, 11 (4): 1628- 1650.
doi: 10.21037/qims-20-677
6 Mozzo P , Procacci C , Tacconi A , et al. A new volumetric CT machine for dental imaging based on the cone-beam technique: Preliminary results[J]. Eur Radiol, 1998, 8 (9): 1558- 1564.
doi: 10.1007/s003300050586
7 Wu TY , Lin HH , Lo LJ , et al. Postoperative outcomes of two- and three-dimensional planning in orthognathic surgery: A compa-rative study[J]. J Plast Reconstr Aesthet Surg, 2017, 70 (8): 1101- 1111.
doi: 10.1016/j.bjps.2017.04.012
8 Adolphs N , Haberl EJ , Liu W , et al. Virtual planning for craniomaxillofacial surgery: 7 years of experience[J]. J Craniomaxillofac Surg, 2014, 42 (5): e289- e295.
doi: 10.1016/j.jcms.2013.10.008
9 Kim DS , Choi SC , Lee SS , et al. Principal direction of inertia for 3D trajectories from patient-specific TMJ movement[J]. Comput Biol Med, 2013, 43 (3): 169- 175.
doi: 10.1016/j.compbiomed.2012.12.007
10 Zhang L , Shen L , Zhang L , et al. Dynamic 3D images fusion of the temporomandibular joints: A novel technique[J]. J Dent, 2022, 126, 104286.
doi: 10.1016/j.jdent.2022.104286
11 李源, 刘木清, 刘博, 等. 基于锥形束CT影像的颞下颌关节髁突骨改建三维定量评价研究[J]. 中华口腔医学杂志, 2020, 55 (9): 617- 623.
doi: 10.3760/cma.j.cn112144-20200507-00249
12 Tecco S , Saccucci M , Nucera R , et al. Condylar volume and surface in Caucasian young adult subjects[J]. BMC Med Imaging, 2010, 10, 28.
doi: 10.1186/1471-2342-10-28
13 侯磊, 叶国华, 刘筱菁, 等. 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[J]. 北京大学学报(医学版), 2020, 52 (1): 113- 118.
14 Marlière DAA , Demétrio MS , Schmitt ARM , et al. Accuracy between virtual surgical planning and actual outcomes in orthognathic surgery by iterative closest point algorithm and color maps: A retrospective cohort study[J]. Med Oral Patol Oral, 2019, 24 (2): E243- E253.
15 陈硕, 刘筱菁, 李自力, 等. 下颌后缩畸形患者正颌外科术后髁突改建的三维影像评价[J]. 北京大学学报(医学版), 2015, 47 (4): 703- 707.
16 Epker BN , Wylie GA . Control of the condylar-proximal mandibular segments after sagittal split osteotomies to advance the mandible[J]. Oral Surg Oral Med Oral Pathol, 1986, 62 (6): 613- 617.
doi: 10.1016/0030-4220(86)90251-3
17 Barretto MDA , Melhem-Elias F , Deboni MCZ . Methods of mandibular condyle position and rotation center used for orthognathic surgery planning: A systematic review[J]. J Stomatol Oral Maxi, 2022, 123 (3): 345- 352.
18 Costa F , Robiony M , Toro C , et al. Condylar positioning devices for orthognathic surgery: A literature review[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 106 (2): 179- 190.
doi: 10.1016/j.tripleo.2007.11.027
19 Jung GS , Kim TK , Lee JW , et al. The effect of a condylar repositioning plate on condylar position and relapse in two-jaw surgery[J]. Arch Plast Surg, 2017, 44 (1): 19- 25.
doi: 10.5999/aps.2017.44.1.19
20 Bethge LS , Ballon A , Mack M , et al. Intraoperative condyle positioning by sonographic monitoring in orthognathic surgery verified by MRI[J]. J Cranio Maxill Surg, 2015, 43 (1): 71- 80.
doi: 10.1016/j.jcms.2014.10.012
21 Marmulla R , Muhling J . Computer-assisted condyle positioning in orthognathic surgery[J]. J Oral Maxil Surg, 2007, 65 (10): 1963- 1968.
doi: 10.1016/j.joms.2006.11.024
22 Quast A , Santander P , Trautmann J , et al. A new approach in three dimensions to define pre- and intraoperative condyle-fossa relationships in orthognathic surgery: Is there an effect of general anaesthesia on condylar position?[J]. Int J Oral Max Surg, 2020, 49 (10): 1303- 1310.
doi: 10.1016/j.ijom.2020.02.011
23 Oh HJ , Moon JH , Ha H , et al. Virtually-planned orthognathic surgery achieves an accurate condylar position[J]. J Oral Maxillofac Surg, 2021, 79 (5): 1146.e1- 1146.e25.
doi: 10.1016/j.joms.2020.12.048
24 Schouman T , Rouch P , Imholz B , et al. Accuracy evaluation of CAD/CAM generated splints in orthognathic surgery: A cadaveric study[J]. Head Face Med, 2015, 11, 24.
doi: 10.1186/s13005-015-0082-9
25 Ritto FG , Schmitt ARM , Pimentel T , et al. Comparison of the accuracy of maxillary position between conventional model surgery and virtual surgical planning[J]. Int J Oral Maxillofac Surg, 2018, 47 (2): 160- 166.
doi: 10.1016/j.ijom.2017.08.012
26 Kaur A , Rattan V , Rai S , et al. Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD): A prospective study[J]. J Cranio Maxill Surg, 2022, 50 (12): 915- 922.
doi: 10.1016/j.jcms.2022.12.003
27 Lee SJ , Yang HJ , Choi MH , et al. Real-time augmented model guidance for mandibular proximal segment repositioning in orthognathic surgery, using electromagnetic tracking[J]. J Craniomaxillofac Surg, 2019, 47 (1): 127- 137.
doi: 10.1016/j.jcms.2018.10.016
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