Evaluation of condylar positioning in bimaxillary orthognathic surgery using intraoperative cone-beam computed tomography

Abstract

Background: Bilateral sagittal split osteotomy (BSSO) constitutes the most used surgical method in the treatment of dentofacial deformities. Alterations in the condylar position, after the BSSO, can lead to recurrence of postoperative malocclusions, temporomandibular joint disorders (TMJ) and condylar resorption. Nowadays, the use of intraoperative cone-beam would allow to objectify the condylar position after the BSSO, avoiding deleterious effects on TMJ for wronged condylar positioning, optimising masticatory efficiency, functionality and postoperative skeletal stability. Objectives: Design a tomographic intraoperative control protocol, with O-Arm cone-beam equipment, of condylar positioning in BSSO on orthognathic surgery (OS) and evaluate its utility. Methods: Clinical prospective study made between July 2013 and August 2016 of 300 patients who underwent OS at the Oral and Maxillofacial Unit, Faculty of Medicine, School of Dentistry Clínica Alemana – Universidad del Desarrollo Clinica Alemana Santiago, Chile. In operating room, after BSSO, with radioprotection protocol, O-Arm cone-beam is used with multiplanar and three-dimensional images. The condylar position is evaluated, and if necessary, new repositioning and new control is made. Conclusions: The use of intraoperative cone-beam is a reliable technique that allows performing an immediate diagnosis of wrong condylar positioning in OS, avoiding future complications.