Abstract
Progressive condylar resorption is an irreversible complication and a factor in the
development of late skeletal relapse after orthognathic surgery. We have evaluated
cephalometric characteristics, signs and symptoms in the temporomandibular joint (TMJ),
and surgical factors in six patients (one man and five women) who developed it after
orthognathic surgery. The findings in preoperative cephalograms indicated that the
patients had clockwise rotation of the mandible and retrognathism because of a small
SNB angle, a wide mandibular plane angle, and a “minus” value for inclination of the
ramus. There were erosions or deformities of the condyles, or both, on three-dimensional
computed tomography (CT) taken before treatment. The mean (SD) anterior movement of
the mandible at operation was 12.1 (3.9) mm and the mean relapse was −6.4 (2.5) mm. The mean change in posterior facial height was 4.5 (2.1) mm at operation and the mean relapse was −5.3 (1.8) mm. Two patients had click, or pain, or both, preoperatively. The click disappeared
in one patient postoperatively, but one of the patients who had been symptom-free
developed crepitus postoperatively. In the classified resorption pattern, posterior–superior
bone loss was seen in three cases, anterior–superior bone loss in two, and superior
bone loss in one. Progressive condylar resorption after orthognathic surgery is multifactorial,
and some of the risk factors are inter-related. Patients with clockwise rotation of
the mandible and retrognathism in preoperative cephalograms; erosion, or deformity
of the condyle, or both, on preoperative CT; and wide mandibular advancement and counterclockwise
rotation of the mandibular proximal segment at operation, seemed to be at risk. The
mandible should therefore be advanced only when the condyles are stable on radiographs,
and careful attention should be paid to postoperative mechanical loading on the TMJ
in high-risk patients.
Keywords
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Article info
Publication history
Published online: March 28, 2011
Accepted:
February 21,
2011
Identification
Copyright
© 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
