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Official Journal of the Italian Society of Maxillofacial Surgery
Online ISSN 1827-1901
THE TEMPOROMANDIBULAR JOINT
Pironi M. 1, Bianchi A. 2, Piccione M. 3, Giorgini F. 2, Marchetti C. 2
1 Graduate School in Maxillofacial Surgery, Alma Mater Studiorum University of Bologna,, Bologna, Italy
2 University Hospital of S. Orsola Malpighi, Bologna, Italy
3 Private practitioner
Aim. In our study we wished to investigate three-dimensional (3D) variations in the condylar position in a group of patients who had undergone orthognathic surgery involving the saggital bilateral osteotomy of the mandibular rami, combining the capability of the cone-beam with software able to generate a 3D cephalometric analysis.
Methods. We selected 38 patients with a dental-skeletal malocclusion with concomitant alterations in facial harmony; only patients who showed no symptoms or signs of dysfunction in the temporomandibular joints were included in the study. All patients were placed under an orthodontic-surgical treatment involving the saggital bilateral osteotomy of the mandibular rami according to Obwegeser-Dal Pont and during surgery condyle position was checked manually. Pre- and post-surgery evaluations of the condylar position were acquired for each patient by two CBCT of the facial mass: the first a week before the surgery, the second three months after the surgical intervention. Data obtained with the CBCT was exported in “DICOM” format and imported using SimPlant-OMS software (Materialize. Belgium). Symplant-OMS software was used to create a 3D cephalometric analysis to give a three dimensional evaluation of the positions of the mandibular condyles in the interior of the glenoid fossae: five points were identified for each condyle (left and right) and three points for each of the two joint fossae (left and right). In addition, a reference system was made with three orthogonal planes: the horizontal plane X, the saggital plane Z, and the vertical plane Y and linear and angular measurements were defined so as to analyze the position of each condyle with respect to the reference system.
Results. Of all parameters considered, only the angulation of the right condyle with respect to the median saggital plane, and to a lesser degree, its transversal position, showed any significant variation between pre- and postsurgery. For all the other variables, the changes were negligible: less than a millimeter (mm) for linear distances or less than a degree (o) for angular measures.
Conclusion. In patients who underwent an osteotomy of the mandibular rami for the correction of a dentofacial dysmorphism, and who didn’t present dysfunction of the temporomandibular joints, the manual intraoperator monitoring of the proximal segments of the osteotomy was able to maintain the condyle in the pre-surgical position.