Independent risk factors for long-term skeletal relapse after mandibular advancement with bilateral sagittal split osteotomy |
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| Affiliation: | 1. Department of Plastic and Reconstructive Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China;2. Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA;3. Harvard Medical School, Boston, Massachusetts, USA;4. Harvard School of Dental Medicine, Boston, Massachusetts, USA;1. Oral and Maxillofacial Surgery Department, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil;2. Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA;3. UNESC School of Dentistry, Criciúma, SC, Brazil;4. Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá – UNIC, Cuiabá, Brazil;5. Division of Oral and Maxillofacial Surgery, Department of Otolaryngology – Head and Neck Surgery, and Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;1. Department of Periodontics, University of Illinois at Chicago, College of Dentistry, Chicago, IL, USA;2. Department Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry, Chicago, IL, USA;3. Department of Oral and Maxillofacial Surgery, University of Rochester, Eastman Institute for Oral Health, Rochester, NY, USA;1. Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA;2. Department of General Surgery, WakeMed Physician Practices, WakeMed Hospital, Raleigh, North Carolina, USA;1. Diagnostic Clinic, Dentistry School, University of San Luis Potosi, San Luis Potosi, Mexico;2. Oral Microbiology, Pathology and Biochemical Laboratory, Dentistry School, Autonomous University of San Luis Potosi, San Luis Potosi, Mexico;1. Department of Oral and Maxillofacial Surgery, Craniomaxillofacial Research Centre, Buali Hospital, Islamic Azad University, Tehran, Iran;2. Department of Oral and Maxillofacial Surgery, University of Toronto, Toronto, Canada;3. Division of Oral and Maxillofacial Surgery, Department of Surgery, Northside Hospital, Georgia Oral and Facial Reconstructive Surgery, Atlanta, GA, USA;4. Department of Oral and Maxillofacial Surgery, Georgia Regents University, Augusta, GA, USA;5. Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University, Atlanta, GA, USA;6. Division of Oral and Maxillofacial Surgery, Department of Surgery, Islamic Azad University, Tehran, Iran |
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| Abstract: | The purpose of this retrospective cohort study was to identify the independent risk factors for long-term skeletal relapse following mandibular advancement with bilateral sagittal split osteotomy. Univariate and multivariate linear regression analyses were performed including nine common risk factors for relapse as independent variables and horizontal/vertical long-term (≥2 years) skeletal relapse as dependent variables. Ninety-six patients were analyzed; 66 were female (68.8%) and the average age of the patients was 29.7 ± 10.5 years. Over an average follow-up of 3.8 ± 1.8 years after an initial mandibular advancement of 8.8 ± 2.4 mm, long-term skeletal relapse of 1.6 ± 1.0 mm horizontal and 0.9 ± 0.7 mm vertical was found. Multivariate analysis identified age, preoperative mandibular plane angle (MPA), bimaxillary surgery, counterclockwise mandibular rotation, and the magnitude of mandibular advancement to be significantly associated with horizontal long-term skeletal relapse. Preoperative MPA, counterclockwise mandibular rotation, and the magnitude of mandibular advancement were significantly associated with vertical long-term skeletal relapse. Thus preoperative MPA, the magnitude of mandibular advancement, and counterclockwise mandibular rotation of the mandible were found to be independent risk factors for both horizontal and vertical long-term skeletal relapse. Although long-term skeletal relapse cannot be avoided entirely, understanding the independent risk factors and their contributions will optimize treatment planning and long-term stability. |
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| Keywords: | mandibular advancement bilateral sagittal split osteotomy relapse stability long-term |
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