Condylar positioning in orthognathic surgery

Abstract

The sag&al split ramus osteotomy of the mandible is a versatile surgical procedure that can be used to correct many skeletal and functional maxillofacial deformities. However, authors in the past 15 years have addressed the problems associated with the improper postoperative position of the proximal or condylar segment of the mandible.‘-l2 The general concern has been that the proximal segment should be maintained in its correct anatomic and preoperative position following the surgical positioning of the distal, or tooth bearing, segment and fixation of the mandible. Failure to correctly position the proximal segment can result in a built-in relapse potential, loss of the gonial angle, condylar sag, pain and dysfunction of the temporomandibular joint, and functional impairment of the masticatory system.‘,‘.5-7.9.12-14 Several authors have proposed techniques and devices by which the correct position of the proximal segment can be maintained both during fixation and postoperativity. 3*4,9~10~13-16 None of these techniques, however, can be used in procedures involving both the mandible and maxilla. These techniques also fail to provide for maintenance of the position of the proximal segment in three dimensions during fixation of the bony segments. Luhr recently described a method using an “L” or “T” shaped miniplate adapted to the lateral ascending ramus and to the maxillary arch wire in mandibular surgery. l7 In this article Luhr also de