下颌支后缘垂直切开上移重建髁突治疗骨软骨瘤

目的:评价下颌支后缘垂直骨切开术用于治疗髁突骨软骨瘤的临床效果.方法:对我院2004-2009年间9例应用髁突切除术及带蒂下颌支后缘上移重建髁突治疗髁突骨软骨瘤的患者进行随访,并通过影像学、咬合关系及颞下颌关节功能进行综合评估.结果:经过至少8个月的随访,所有患者髁突重建后的咬合关系、面形及关节功能均恢复良好.影像学检...     

Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis

The traditional approach for ankylosis is gap arthroplasty or interpositional arthroplasty followed by reconstruction of the condyle using, for example, costochondral grafts. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry and deviated mouth opening. The authors have applied the method of total and partial sliding vertical osteotomy on the posterior border of the mandibular ramus for reconstruction of the mandible condyle as a pedicled graft for the correction of temporomandibular joint (TMJ) ankylosis. From 2004 to 2008, 18 patients who were diagnosed with TMJ ankylosis underwent operations for resection of the ankylosed condyle. Two methods were performed depending on the level of osteotomy on the posterior part of the mandibular ramus. All patients were followed-up for an average of 36 months (range 24-48 months). All patients showed apparent improved joint function with no cases of re-ankylosis. The results showed that sliding vertical osteotomy on the posterior border of the mandibular ramus seems to be an alternative and promising method for condylar reconstruction in patients with TMJ bony ankylosis.     

Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series

The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO).Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the “new condyle” and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8–12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the “new condyle” moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved.Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.     

Osteochondroma of the mandibular condyle: literature review and report of a case

AIM: The intent of this report is to present a brief review of the literature on osteochondroma and to present a case involving the surgical removal and replacement of a major portion of the condyle and angle of the mandible using free autogenous mandibular bone. BACKGROUND: While osteochondroma is the most common tumor of skeletal bones, it is relatively uncommon in the jaws occurring at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. REPORT: A case of a 29-year-old woman with an osteochondroma of the mandibular condyle is presented. Surgical treatment was tumor resection, grafting, and reshaping of the mandibular angle and ramus. As this lesion is usually asymptomatic and discovered incidentally on radiographic examination, the general practitioner usually is the first professional to make the diagnosis. SUMMARY: Condylectomy cannot be recommended as routine in all cases.37 Common surgical treatments include condylectomy and reconstruction.24 If the tumor involves only a limited area of the condylar surface, then preservation of the remaining portion of the condyle and reshaping should be done. Reasons for not taking such a conservative approach are the possibilities of malignancy and the risk of recurrence. In this case report the extraoral vertical ramus osteotomy, associated with free autogenous mandibular bone, presented several advantages.     

Excision of condylar osteochondroma by vertical ramisection with immediate TMJ reconstruction

In literature, excision of condylar osteochondroma is usually performed by preauricular incision. In Oct 1984 according to the experience of "Z" form osteotomy and bone graft to reconstruct the TMJ, a new method for excision of condylar osteochondroma was used by the first author, i.e. (1) making a vertical ramisection by subauricular incision; (2) excising the condylar osteochondroma with the posterior part of the ramus; (3) excising the condyle with osteochondroma on the surgical table, and (4) immediately reconstructing the TMJ with the surplus bone fragment at the same operation. Since 1984-1987, 7 cases have been performed by this method with excellent results. The details of the operation were described and discussed.     

Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry

This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. The postoperative outcome was assessed for facial symmetry and surgical accuracy. All patients were followed up for at least 18 months and their level of satisfaction was investigated. Use of the computer-assisted osteotomy guides and pre-bent titanium plates was successful in all patients. Maxillary canting, mandibular ramus inclination, and mandibular length were corrected on both sides postoperatively. Superimposition of the surgical simulation and postoperative images demonstrated favourable accuracy. Quantitative analysis revealed a mean linear difference of <0.60 mm in the maxilla and 1.57 mm in the mandible. All patients were satisfied with the surgical outcome; there were no complications or cases of relapse during follow-up. The application of computer-assisted osteotomy guides and pre-bent titanium plates achieved favourable outcomes and accuracy, improving planning for the correction of facial asymmetry.     

Three-dimensional evaluation of positional change of the condyle after mandibular setback by means of bilateral sagittal split ramus osteotomy

OBJECTIVE: The aim of this study was to evaluate condylar displacement in 3 dimensions by means of computed tomography after mandibular setback by sagittal split ramus osteotomy with rigid fixation and to compare these results with those from patients with mandibular advancement. STUDY DESIGN: Thirty Korean subjects with skeletal class III malocclusion who had undergone mandibular setback by sagittal split ramus osteotomy had computed tomographs taken. Tomographs were taken to evaluate the temporomandibular joint 1 month before and approximately 1 month after surgery. The position and angulation of the condyle were measured on axial or sagittal views. These measurements were analyzed to determine any correlations between the amount of mandibular movement and condylar displacement. RESULTS: The results of this study show that the condyle tends to move inferiorly and rotate inward on the axial view and backward on the sagittal view by a statistically significant amount. CONCLUSION: The positional change of the condyle after sagittal split ramus osteotomy was not correlated with the amount of the setback.     

Comparison of the clinical effects of treatment of osteochondroma by two types of vertical ramus osteotomy

The purpose of this retrospective study was to evaluate 10 patients with osteochondroma of the mandibular condyle who were treated by vertical ramus osteotomy. Three patients had resection of the condyle and reconstruction with free vertical ramus osteotomy grafts (free graft group) and seven had pedicled vertical sliding ramus osteotomy grafts (pedicled graft group). The mean (range) observation period was 30 months. All patients had satisfactory clinical outcomes, and facial symmetry and good occlusion were achieved during the first 10 months. However, slight facial asymmetry was observed in patients treated by free grafts at 11 months, as the mandible deviated to the operated side when the mouth was opened. Postoperative radiographs showed varying degrees of neocondylar resorption and reduction in height. Patients treated with pedicled grafts did not develop these symptoms, and had no bony resorption to speak of on radiographs taken during the follow-up period. In conclusion, the advantages of the pedicled graft over the free graft include less bony resorption and better long-term clinical outcomes.     

双颌手术升支截骨后退术后下颌稳定性及与关节关系的研究

目的　探讨升支矢状劈开截骨术(BSSRO)小钛板坚固内固定与口内入路升支垂直截骨术(BIVRO)下颌后退术后颌稳定性的不同规律,了解导致复发的有关因素特别是髁状突移位在不同手术后复发过程中的意义。方法　升支截骨手术后退下颌的患者共38例,皆为双颌手术,其中下颌BSSRO19例,BIVRO后退术19例。于手术前1周(T1),手术后1周(T2),3个月(T3)及1年(T4)分别拍摄定位头颅侧位片及定位颞下颌关节薛氏位片用于测量下颌移动幅度及关节髁状突的手术后移位。结果　双颌手术下颌升支截骨后退术后,BSSRO坚固内固定组1年时的复发率为25%,而BIVRO组大部分患者1年时下颌发生了与手术目的相同的移动,两组的不稳定主要发生在术后3个月内。结论　手术使髁状突移位术后位置的调整可导致BIVRO术后的下颌继续后移而不稳定,而髁状突近心骨段术中向后旋转术后位置的调整可导致BSSRO术后的下颌骨继续向前而不稳定     

下颌升支垂直截骨内固定术治疗髁突高位骨折

目的:比较手术和非手术方法治疗单侧下颌骨髁突高位骨折的临床效果。方法:19例髁突高位骨折患者,其中10例行下颌升支截骨内固定术+颌间牵引术(手术组),其余9例单纯行颌间牵引术(非手术组),随访0.5～1年。结果:手术组和非手术组之间比较,开口度及前伸运动度均无显著性差异(P>0.05);侧方运动度手术组优于非手术组,有显著性差异(P<0.01)。非手术治疗的患者,下颌骨平面不对称,X线片显示髁突的解剖位置欠佳。手术患者,下颌下区存在线形疤痕,但下颌骨平面对称,X线片显示患侧髁突与健侧形态相似。19例中无1例出现明显的颞下颌关节紊乱综合征。结论:采用下颌升支垂直截骨内固定术+颌间牵引术治疗下颌骨髁突高位复杂骨折,兼顾美观和功能,手术简便,不失为一种理想的治疗方法。     

计算机辅助下颌骨髁突外生性骨软骨瘤的手术切除

目的:利用计算机辅助设计(computer assisted designing,CAD)指导下颌骨髁突(mandibular condyle)外生性骨软骨瘤(exostosis osteochondroma)的瘤体切除,并评价其应用效果。方法:8例患者采用Surgicase CMF 5.0软件进行瘤体切除的术前设计。术后将CT数据与术前设计进行融合,并利用SAS8.0软件包对手术前、后髁突形态测量值进行配对t检验,评价手术效果。结果:8例患者瘤体均完整切除,术后髁突形态与术前设计吻合度高,平均误差为(1.82±1.25)mm。结论:计算机辅助设计可于术前合理选择截骨线部位,有助于肿瘤的完整切除及患侧正常部分髁突的保存。     

Endoscopic vertical ramus osteotomy: early clinical results.

PURPOSE: The benefits of minimally invasive surgery have been well documented. The purpose of this report was to present early results in a series of patients who had endoscopic mandibular orthognathic surgery.Patients and methods This is a retrospective evaluation of 14 patients who underwent endoscopic vertical ramus osteotomy and rigid fixation for the treatment of mandibular prognathism (n = 9), malocclusion secondary to trauma (n = 3), or other pathology (n = 2). A 1.5-cm incision was made directly below the mandibular angle. The dissection was continued bluntly to the masseter muscle, which was incised using a needlepoint electrocautery. Then, with endoscopic elevators, an optical cavity was created for insertion of a Hopkins endoscope and visualization of the ramus/condyle unit. Anatomic landmarks were identified and the operation carried out with specially designed endoscopic equipment. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations; lateral cephalograms; and panoramic radiographs were used to evaluate the outcomes. RESULTS: The procedures performed included: vertical ramus osteotomy (n = 13 patients, 23 sides) and condylectomy plus vertical ramus osteotomy (n = 1 patient, 1 side). Mean operating time was 37 minutes per side. One patient had temporary marginal mandibular nerve weakness. The occlusal result was as planned in all cases. Panoramic radiographs documented postoperative ramus/condyle unit position and lateral cephalograms documented mandibular position. CONCLUSIONS: The results of this case series indicate that endoscopic vertical ramus osteotomy with rigid fixation is feasible for correction of a variety of mandibular deformities.     

Computer-assisted condylar reconstruction in bilateral ankylosis of the temporomandibular joint using autogenous coronoid process

During the past 10 years, more than 20 patients a year have been treated at our centre for bilateral ankylosis of the temporomandibular joint (TMJ). Here we describe the use of computer-assisted three-dimensional surgical planning and its clinical effects in condylar reconstruction for such patients using autogenous coronoid process. Sixteen patients with bilateral bony ankylosis of the TMJ from March 2006 to March 2009 were randomly divided into 2 groups and treated by bilateral osteoarthrectomy and condylar reconstruction by free grafting of autogenous coronoid process with and without three-dimensional simulation using Surgicase CMF™ (Materialise, Belgium) software. Clinical examination, radiographs, photographs, and details of the operation and its outcome were used postoperatively to evaluate the clinical effects of the technique. Satisfactory mouth opening was achieved in all cases. There were fewer postoperative malocclusions among patients who had three-dimensional simulation. The combination of computer-assisted three-dimensional surgical planning and simulation and free grafting of autogenous coronoid process is a sound and predictable method for the reconstruction of condyles in patients with bilateral ankylosis of the TMJ as it makes the operation easier and more accurate.     

Condylar reconstruction by oblique sliding vertical-ramus osteotomy.

INTRODUCTION: The posterior border of the mandibular ramus can be used as a pedicled graft for reconstruction of the condyle. This article describes a technique that is better in certain situations than the use of other autogenous grafts or alloplastic materials. PATIENTS AND METHODS: Three adult patients, two with osteochondroma and one with hyperplasia were treated by condylectomy and simultaneous reconstruction with the pedicled posterior mandibular border. A meticulous oblique osteotomy and reinsertion of the lateral pterygoid muscle was performed. RESULTS: In all three cases an immediate mouth opening with stable occlusion was achieved. The interincisal opening was more than 40 mm after 3 weeks, with a deviation no greater than 4mm towards the affected side. All excursive movements were present in all directions, and correction of the facial asymmetry was achieved. There was no T.M.J. pain and all patients expressed satisfaction during the follow-up of 56 months (average). An adequate remodelling of the neocondyle without resorption as well as a stable occlusion was observed in every case. CONCLUSION: Reconstruction of the condyle by sliding vertical-oblique ramus osteotomy provides, in cases of condylar tumours, excellent functional and cosmetic results.     

Three-dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy

Objective. The purpose of this study was to examine both condylar displacement of the temporomandibular joint after sagittal split ramus osteotomy with rigid osteosynthesis and intraoral vertical ramus osteotomy without osteosynthesis in patients with mandibular prognathism by means of three-dimensional computed tomography.Study design. In this pilot study, five patients treated with sagittal split ramus osteotomy and 5 patients treated with intraoral vertical ramus osteotomy were evaluated. A technique to superimpose a postoperative three-dimensional computed tomography image on its corresponding preoperative image was designed. Postoperative condylar displacement, rotation, and tilting were measured in three-dimensional computed tomography images.Results. Within 3 to 6 months after surgery, changes in the inclination of the condylar axes were distinctly seen, although changes in the position of the condyles within the joints were minimal. In particular, outward rotation of the condylar long axes after intraoral vertical ramus osteotomy was a frequent finding.Conclusions. The three-dimensional computed tomography superimposition technique was a practical method of evaluating post-surgical condylar displacement after mandibular osteotomy.     

Retromandibular approach to condyle fractures: two case reports

Retromandibular approach was first described in 1967 for vertical subcondylar osteotomy and later became popular for surgical treatment of temporomandibular joint dysfunction and low condyle fractures. The trajectory of the incision, parallel to the posterior border of the mandibular ramus, allows a good approach with easy separation of the buccal and marginal mandibular branches of the facial nerve, when they are present in the surgical field. When open reduction and internal rigid fixation with plates and screws are indicated for condylar fractures, retromandibular approach offers an excellent esthetic result with low morbidity. Two clinical cases are presented, in which the surgical treatment was carried out for condylar fractures, and clearly illustrate the proposed approach.     

髁突骨折手术治疗临床分析

目的:探讨髁突骨折手术治疗的不同术式、适应证、手术治疗程序,为临床治疗提供依据。方法:对112例髁突骨折临床资料进行分析,按照X线诊断、临床表现、骨折部位、移位程度、致伤时间等因素确定不同术式,观察其术后即期与远期效果,其中38例行传统切开复位内固定术,53例行不游离髁突的升支切开解剖复位术,18例行游离髁突和升支骨段倒置关节重建术,3例行游离髁突升支切开复位重建术。结果:各种不同的手术治疗方式均可获得较好的即期效果,但远期效果以不游离髁突的升支切开解剖复位术最佳。结论:对于大多数髁突骨折,尤其是中、低位骨折,脱位,移位或严重成角者以不游离髁突的升支切开解剖复位术效果最好。髁突粉碎骨折和陈旧骨折宜行游离髁突和升支骨段倒置关节重建术。髁突高位骨折宜行游离髁突升支切开复位重建术。     

计算机辅助设计和制作技术在髁突骨软骨瘤合并颌骨畸形治疗中的应用:附1例报告

目的:探讨计算机辅助设计与制作(computer-aided design/manufacture,CAD/CAM)技术在髁突骨软骨瘤合并颌骨畸形治疗中的应用。方法:髁突骨软骨瘤合并上、下颌骨畸形1例,采用计算机辅助设计技术(SurgiCase CMF 5.0软件进行CT数据处理)模拟切除肿瘤,上、下颌骨截骨,设计虚拟中间和终末板及截骨导板,并进行术后效果预测;应用快速原型(rapid prototyping,RP)技术制作中间板和截骨导板,术中应用。术后进行CT检查,并与术前设计进行比较,评价应用效果。结果:术后CT显示,截骨效果与术前设计吻合度高,术后随访6个月肿瘤无复发,患者面形对称。结论:应用CAD/CAM技术进行髁突肿瘤切除及合并颌骨不对称畸形的辅助治疗,可以提高手术的准确性,节约手术时间,具有一定的应用前景。     

Digital cutting guide and endoscopically-assisted vertical ramus osteotomy to treat condylar osteochondroma: a long-term study

We have introduced an effective treatment for mandibular condylar osteochondroma with a digital cutting guide and endoscopically-assisted vertical ramus osteotomy (VRO). Eleven patients with unilateral condylar osteochondroma, who did not require orthognathic surgery or had less than 3 mm deviation of the chin and a stable occlusion, were treated during the period April 2013–January 2017 with a digital cutting guide and endoscopically-assisted VRO. Clinical data collected included the occlusion, facial contour, and maximum mouth opening (MMO). Computed tomographic (CT) scans were taken before and after operation. Two patients also had additional shaping of the mandibular contour. The pathological diagnosis was confirmed to be osteochondroma in all cases. A mean (range) 19 (12–40) months of follow-up for all 11 cases showed stable postoperative occlusion and facial aesthetics. There were no functional disturbances, recurrence, or condylar absorption. VRO is an alternative to orthognathic surgery for patients with osteochondroma who do not have severe malocclusions. The digital cutting guide and endoscopically-assisted VRO make it possible to achieve precise resection of the tumour and maintain the occlusion with minimal invasion.     

3D打印导板辅助髁突骨软骨瘤及继发复杂牙颌面畸形的手术治疗

目的:研究3D打印手术导板辅助髁突骨软骨瘤及继发牙颌面畸形同期矫治的临床可行性。方法:根据影像学资料,运用Dolphin Imaging 11.7 Premium 和Mimics软件进行虚拟外科手术设计并制作3D打印手术导板,指导髁突骨软骨瘤及继发牙颌面畸形的手术矫治。通过对比模拟头颅模型与实际术后CT重建模型评估此方法的临床价值。结果:所有患者患侧关节功能、咬合关系以及颜面对称性都得到了良好的恢复。模拟术后模型与术后扫描重建模型对比中,中切牙与第一磨牙的误差均保持在1.4 mm以下,最大误差出现在颏部,约2.4 mm,显示了新方法的准确性。结论:结果显示虚拟外科手术设计和手术导板有助于髁突骨软骨瘤继发牙颌面畸形的准确诊断、治疗方案设计、准确截骨以及重置骨块。