Abstract
The aim of the study was to quantify the postoperative condylar remodeling after Le Fort I surgery.Patients treated with a Le Fort I osteotomy were investigated. CBCT scans were acquired preoperatively, one week and one year postoperatively. A preoperative 3D cephalometric analysis was performed on the preoperative CBCT. Surgical movements were quantified using a voxel-registration based method (OrthoGnaticAnalyser). After rendering of the condyles from the CBCT, a volumetric analysis was performed. The correlation between the surgical movement of the maxilla and the postoperative condylar volume changes was determined with analysis of variance. ResultsA total of 45 subjects were included in this study. 47 of 90 condyles (52%) showed a mean volume reduction of 93 mm3 (4.9 volume-%) postoperatively. The maxilla was impacted in 12 patients (2.44 ± 2.49 mm) and extruded in 33 patients (1.78 ± 1.29 mm). The maxillary impaction group showed a volume reduction of 50 ± 122 mm3 and the extrusion group showed a mean volume gain of 21 ± 139 mm3 (p = 0.028). ConclusionClinicians should be aware of potential condylar remodeling following solitary Le Fort I osteotomies, particularly in female patients with maxillary impaction.
Highlights
Following orthognathic surgery, a certain amount of postoperative skeletal relapse is often observed (Convens et al, 2015; Xi et al, 2015; Ragaey and Van Sickels 2017; Xi et al, 2017; Nunes de Lima et al, 2018)
Postoperative relapse is associated with a malpositioning of one or both condyles during surgery and the consequent unfavorable position of the mandible (Park et al, 2012; Xi et al, 2015; Jung et al, 2018; Miao et al, 2018; Ha et al, 2020; Quast et al, 2020; Hsu et al, 2021; Nin~o-Sandoval et al, 2021) Condylar remodeling and significant morphological condylar changes are associated with late postoperative relapse (>12 months following surgery), known as progressive condylar resorption (PCR) (Arnett et al, 1996; Hoppenreijs et al, 1999; Jung et al, 2018; Miao et al, 2018; Kretschmer et al, 2019; Francisco et al, 2020; Quast et al, 2020; Ehardt et al, 2021)
A total of 45 patients were included in this study, 35 from Radboudumc and 10 from KULeuven
Summary
A certain amount of postoperative skeletal relapse is often observed (Convens et al, 2015; Xi et al, 2015; Ragaey and Van Sickels 2017; Xi et al, 2017; Nunes de Lima et al, 2018). A change in position of the mandible can be a consequence of condylar remodeling in response to positional change of the condyles after surgery (Park et al, 2012; Lee et al, 2013; Xi et al.2015, 2017; Kraeima et al, 2016; Quast et al, 2020; Ehardt et al, 2021) It has been reported that after the rigid plate fixation was introduced, the relapse at the ostomy sites was significantly reduced. Three-dimensional analysis of condylar remodeling and skeletal relapse following LeFort-I osteotomy: A one-year follow-up bicenter study, Journal of Cranio-Maxillo-Facial Surgery, https://doi.org/10.1016/ j.jcms.2021.09.021
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