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.
Keywords
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Article info
Publication history
Published online: July 06, 2020
Accepted:
June 5,
2020
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
