Biomechanical effect of asymmetric mandibular prognathism treated with BSSRO and USSRO on temporomandibular joints: a three-dimensional finite element analysis |
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| Institution: | 1. University of Leeds, Clarendon Way, Leeds, LS2 9JT;2. Department of Oral and Maxillofacial Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX;1. State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China;2. Department of Orthodontics, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Road, Shanghai, PR China;3. State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China;1. Oral and Maxillofacial Surgery Department, Hospital Universitari Quirón Dexeus, Barcelona, Spain;2. Oral and Maxillofacial Surgery Department, Hospital Universitari, Hospital Parc Tauli, Sabadell, Spain;3. Oral and Maxillofacial Surgery Department, Clínica Platón, Barcelona, Spain;1. Service de chirurgie maxillo-faciale et plastique de le face, CHU Clocheville, 37044 Tours, France;2. Service de neurochirurgie pédiatrique, CHU Clocheville, 37044 Tours, France;3. Centre de compétence craniosténoses et malformations craniofaciales rares, CHU Clocheville, 37044 Tours, France;1. University of Aveiro, Biomechanics Research Group, Department of Mechanical Engineering, 3810-193 Aveiro, Portugal;2. Department of Maxillofacial Surgery, Virgen Del Rocio University Hospital, Av. Manuel Siurot s/n, Seville 41013, Spain;3. Department of Surgery, School of Medicine, University of Seville, Dr. Fedriani Av., Seville 41009, Spain;4. University of Bordeaux, Institut de Mécanique et d’Ingénierie, CNRS UMR 5295, FR-33405 Talence, France;1. Private Practice, 19, rue de Téhéran, 75008 Paris, France;2. Consultant, DRA Villa 747 Jumeirah Beach Road, Dubai, United Arab Emirates |
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| Abstract: | Asymmetric mandibular prognathism is a clinically common skeletal dentomaxillofacial deformity. Unilateral sagittal split ramus osteotomy (USSRO) is an effective alternative procedure to bilateral sagittal split ramus osteotomy (BSSRO) for some patients. However, the biomechanical effect of temporomandibular joint (TMJ) of USSRO has not been fully studied. This study aims to evaluate the stress distribution changes in the TMJ of asymmetric mandibular prognathism treated with BSSRO/USSRO, to validate the clinical feasibility of USSRO. Nineteen patients with mandibular prognathism patients who were treated with BSSRO (n = 12) and USSRO (n = 7) had preoperative and postoperative computed tomographic scanning. Preoperative and postoperative 3-dimensional finite element analysis (FEA) of functional TMJ movements were made on one BSSRO patient and one USSRO patient. In all patients, the ANB angle and mandibular deviation were significantly improved postoperatively. There was no significant difference in the postoperative ANB angle and mandibular deviation between the BSSRO group and the USSRO group. In two preoperative FEA models, the maximum stresses of non-deviation side TMJ structures were greater than the deviation side during functional movements. The unbalanced stress distribution was corrected postoperatively in both BSSRO/USSRO FE models. Both BSSRO/USSRO can improve the ANB angle and mandibular deviation. The bilateral TMJ structure in patients with asymmetric mandibular prognathism had unbalanced stress, which could be significantly improved with the USSRO as effectively as BSSRO. |
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| Keywords: | sagittal splint ramus osteotomy (SSRO) unilateral sagittal splint ramus osteotomy (USSRO) asymmetric mandibular prognathism condyle positional change finite element analysis |
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