ABSTRACT
PURPOSE: To analyse the possible morphologic and positional changes of the mandibular condyles after orthognathic surgery. MATERIAL AND METHODS: A prospective cohort study was performed. Patients with mandibular retrognathism were surgically treated to advance the mandible. The study group included seventeen patients (34 condyles) treated with sagittal split osteotomies alone (4 patients) or in combination with maxillary osteotomies (13 patients). Only condyles located on the mandibular side that advance during surgery were studied, therefore only 25 condyles entered this prospective study. Beside it, a group of 6 patients undergoing maxillary surgery as only procedure, maxillary group, was also studied to determinate the influence of maxillary surgery on condylar displacement. Computed tomographies and lateral cephalometric radiographs were performed two weeks before surgery and one year after the surgical procedures. Different variables which analyse the position and morphology of the mandible were studied. The data obtained were analysed statistically by computing R2 values. RESULTS: In the maxillary group they were small displacements in magnitude and not significant. In the study group, 8 condyles showed morphological changes with alteration on reference points. In the remainder 17 condyles different displacements were noted after surgery. Several of these positional changes were predictable and did not affect postoperative mandibular stability. CONCLUSIONS: condylar displacements that occur after sagittal split osteotomies for mandibular advancement show significant correlation with the degree of mandibular advancement and can be defined by mathematical formulae. Maxillary osteotomies do not seem to influence condylar position when bimaxillary procedures take place.
Subject(s)
Mandibular Advancement/methods , Mandibular Condyle/anatomy & histology , Mandibular Condyle/surgery , Osteotomy, Sagittal Split Ramus/methods , Retrognathia/surgery , Adult , Cephalometry , Female , Humans , Male , Mandibular Condyle/diagnostic imaging , Middle Aged , Prospective Studies , Retrognathia/diagnostic imaging , Retrognathia/pathology , Tomography, X-Ray Computed , Young AdultABSTRACT
PURPOSE: To study the complications of temporomandibular joint (TMJ) arthroscopic procedures using two-portal coblation technologies. MATERIALS AND METHODS: The 397 consecutive patients (475 joints) who underwent arthroscopic surgery were prospectively analyzed. RESULTS: Complications were observed in 39 (8.21%) procedures. Complications recognized during or immediately after surgery were observed in 25 cases (5.26%). Vascular injury in the points of trocar insertion was observed in seven cases. Lesions of the fibrocartilage layer of the joint secondary to introduction of instruments were observed in 12 cases. Bleeding within the superior joint space was observed in 21 cases. Extravasation of irrigation fluid appeared in five patients, affecting the oropharyngeal space in one case. In 20 patients, more than one complication at the time of surgery occurred. Delay postoperative complications were noted in 14 patients. Blood clots in the external auditory canal were found in eight cases and lacerations in two cases. One patient experienced partial hearing loss, and two patients experienced vertigo. Temporary hypoesthesia of the auriculotemporal nerve was seen in two patients. Temporary damage to the V cranial nerve was observed in four patients. Temporary paralysis of the zygomatic branch of the facial nerve was seen in one patient. CONCLUSION: TMJ arthroscopy using coblation technologies is a safe surgical procedure when performed by experienced surgeons.
