Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite - A clinical and radiological study
Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite - A clinical and radiological study
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DOI：
10.1016/s0901-5027(98)80301-9
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发表时间：
1998-04-01
影响因子：
2.4
通讯作者：
van't Hof, MA
中科院分区：
文献类型：
--
作者：
Hoppenreijs, TJM;Freihofer, HPM;van't Hof, MA
从三个不同的机构收集了259例垂直上颌骨增生，下颌发育不全和前垂直开牙合患者的样本，分析了颞下颌关节（TMJ）的声音，髁状突重塑和髁状突吸收。所有患者均行Le Fort I截骨术，117例患者行双侧矢状劈开推进截骨术。149例行骨内钢丝固定，110例行坚强内固定。术前、术后即刻、术后1年和最后随访时，可获得头影测量和正断层X线片。平均随访69个月（范围20-210个月）。颞下颌关节音的患者数量从38%下降到31%。最后一次随访时，23.6%的患者出现髁突重塑，7.7%的患者出现单侧髁突吸收，7.7%的患者出现双侧髁突吸收。髁状突轮廓，根据正断层X线片评估，分为五种不同的类型。先前存在骨关节病的放射学征象或具有后倾的髁突具有进行性吸收的高风险。前牙严重开牙合、下颌平面角高、后前面部高度比低的女性患者，在接受双颌截骨术后，更容易发生髁突吸收。骨丢失主要发生在髁突前部。双颌截骨术后髁突吸收的发生率（23%）显著高于单纯Le Fort I侵入截骨术后（9%）。通过使用刚性内固定避免颌间固定倾向于减少髁突变化，特别是在仅接受Le Fort I型截骨术的患者中。双颌截骨术中的刚性内固定导致30%的患者髁突重塑，19%的患者髁突进行性吸收。在双侧矢状劈开截骨术中使用微型接骨板或定位螺钉后，髁突变化无显著差异。
A sample of 259 patients with vertical maxillary hyperplasia, mandibular hypoplasia and anterior vertical open bite, collected from three different institutions, was analysed regarding temporomandibular joint (TMJ) sounds, condylar remodelling, and condylar resorption. All patients underwent Le Fort I osteotomies, and bilateral sagittal split advancement osteotomies were performed in 117 patients. Intraosseous wire fixation was used in 149 and rigid internal fixation in 110 patients. Cephalometric and orthopantomographic radiographs were available before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). The number of patients with TMJ sounds decreased from 38% to 31%. At the latest follow up 23.6% of the patients showed condylar remodelling, 7.7% unilateral condylar resorption and 7.7% bilateral condylar resorption. Condylar contours, as assessed on orthopantomographic radiographs, were classified as five different types. Condyles with preexisting radiological signs of osteoarthrosis or having a posterior inclination were at high risk for progressive resorption. Female patients with severe anterior open bite, high mandibular plane angle and a low posterior-to-anterior facial height ratio, who underwent a bimaxillary osteotomy, were prone to condylar resorption. Bone loss was predominantly found at the anterior site of the condyle. The incidence of condylar resorption was significantly higher after bimaxillary osteotomies (23%) than after only Le Fort I intrusion osteotomies (9%). Avoidance of intermaxillary fixation by using rigid internal fixation tended to reduce condylar changes, in particular in patients who underwent only a Le Fort I osteotomy. Rigid internal fixation in bimaxillary osteotomies resulted in condylar remodelling in 30% and progressive condylar resorption in 19% of the patients. Condylar changes were not significantly different after using either miniplate osteosynthesis or positional screws in bilateral sagittal split osteotomy procedures.