Dataset Information

Three-Dimensional Changes in the Mandibular Proximal Segment After Using a Surgery-First Approach in Patients With Class III Malocclusion and Facial Asymmetry.

ABSTRACT:

Abstract

This study was performed to evaluate condylar position and angulation after asymmetric mandibular setback between a conventional (CA) and surgery-first approach (SFA) using three-dimensional analysis. The condylar positions of 30 patients with skeletal Class III malocclusion and facial asymmetry who underwent 1-jaw (sagittal split ramus osteotomy) or 2-jaw orthognathic surgery (Le Fort I osteotomy and sagittal split ramus osteotomy) with CA (n = 18) or SFA (n = 12) from 2 university hospitals were studied. The three-dimensional assessment of condylar changes was performed using computed tomography images at the initial time point (T0) and at least 6 months after surgery (T1). Segmentation of condyles and cranial base assessment from cone-beam computed tomography images were performed using ITK-SNAP software (version 3.4.0). Condylar position and angulation changes were calculated using 3D Slicer software (version 4.10.2), and statistical analysis was performed. No significant translational or rotational condylar changes were observed between the deviated and non-deviated sides in each group or between the CA and SFA groups except yaw ( p = 0.014). Linear mixed-model analysis and multi-variate analysis showed no significant difference between the CA and SFA groups. Surgery-first approach might not be associated with more harmful effects on the condylar position and angulation changes as compared with CA.

SUBMITTER: Kim M

PROVIDER: S-EPMC9378743 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Three-Dimensional Changes in the Mandibular Proximal Segment After Using a Surgery-First Approach in Patients With Class III Malocclusion and Facial Asymmetry.

Kim MyungSu M Jha Nayansi N Choi Jae-Hong JH Kim Yoon-Ji YJ Lee Uilyong U Cevidanes Lucia L Choi Jin-Young JY Baek Seung-Hak SH

The Journal of craniofacial surgery 20220216 7

<h4>Abstract</h4>This study was performed to evaluate condylar position and angulation after asymmetric mandibular setback between a conventional (CA) and surgery-first approach (SFA) using three-dimensional analysis. The condylar positions of 30 patients with skeletal Class III malocclusion and facial asymmetry who underwent 1-jaw (sagittal split ramus osteotomy) or 2-jaw orthognathic surgery (Le Fort I osteotomy and sagittal split ramus osteotomy) with CA (n = 18) or SFA (n = 12) from 2 univer ...[more]

PMID: 35175981

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Project description:PurposeWe aimed to comprehensively analyse a possible correlation between skeletal malocclusions, gender and mandibular characteristics in all three dimensions in adults and to identify mandibular characteristics that are typical for extreme skeletal patterns.MethodsA 3D model of the skull was calculated in 111 adult patients (mean age = 27.0 ± 10.2 years; 49 women, 62 men) from available computed tomography or cone beam computed tomography scans of their heads. Based on the 3D models, the skeletal patterns were examined in (a) the transversal dimension regarding asymmetry according to menton deviation, (b) the sagittal dimension according to the Wits appraisal and (c) the vertical dimension according to the maxillomandibular plane angle. The mandibular characteristics assessed were linear (ramus height and width, body length), angular (ramus, gonial and body angle) and volumetric (ramus/mandibular volume, body/mandibular volume) parameters.ResultsNo correlation between transversal skeletal asymmetry and mandibular characteristics were found, while sagittal (F(16, 174) = 3.32, p < 0.001, η2 = 0.23) and vertical (F(16, 174) = 3.18, p < 0.001, η2 = 0.23) skeletal patterns were shown to have a significant effect on the mandible. Gender correlated with mandibular characteristics independently from the skeletal pattern. Discriminant analysis revealed that class II and III patients differed in ramus and body angle with class II patients showing higher angles (ramus angle: class II = 89.8 ± 3.9° vs. class III = 84.4 ± 4.8°; body angle: class II = 87.7 ± 4.8° vs. class III = 82.1 ± 5.2°). Hypo- and hyperdivergent patients were discriminated by gonial angle, body angle and body/mandibular volume with hyperdivergent patients having a greater gonial and body angle and body/mandibular volume (gonial angle: hypodivergent = 114 ± 9.3° vs. hyperdivergent = 126.4 ± 8.6°; body angle: hypodivergent = 82.9 ± 4.4° vs. hyperdivergent = 87.7 ± 6.5°; body/mandibular volume: hypodivergent = 72.4 ± 2.7% vs. hyperdivergent = 76.2 ± 2.6%).ConclusionWhen analysing 3D data for treatment planning of adult patients, the orthodontist should pay attention to angular and volumetric characteristics of the mandible to identify extreme skeletal sagittal or vertical malocclusions.

Project description:Non-syndromic facial asymmetry is commonly found in dentofacial deformity populations with skeletal malocclusions. Asymmetry of this type may result from imbalanced growth and function of both the jaw and associated muscles. Among the multiple genes that interact to affect the craniofacial musculoskeletal complex during pre and postnatal growth and development, NODAL signaling pathwy (NSP) genes are active in adult skeletal muscle and may be key factors in development, growth and maintenance of facial asymmetry. It is of interest to determine whether expression of NODAL pathway genes might differ in masseter muscles between individuals with malocclusion that have facial asymmetry and normal symmetry. Human Transcriptome 2.0 GeneChips (HTA2.0) were used to examine global gene expression in masster muscles between malocclusion subjects with posterior facial asymmetry and with normal facial symmetry. Eleven patients undergoing orthoganthic surgery were selected for comparison of masseter muscle gene expression on microarrays. Two subjects had posterior facial asymmetry (one with class II open bite and one with class III open bite malocclusion) and nine subjects had normal facial symmetry (three with class II open bite, two with class III open bite and four with class II deep bite malocclusion). RNA representative of total gene expression in masseter muscles of the malocclusion subjects with and without posterior facial asymmetry was prepared for labeling and hybridization on HTA2.0 chips. The two subjects with facial asymmetry clustered separately from eight other malocclusion subjects by a principle component analysis (PCA), even though one had a class II and the other a class III malocclusion. Sample 4L_Open_II is from a subject who has sleep apnea. Data from 4L_Open_II clustered independent of the asymmetry group and the eight other subjects of the symmetry group by PCA and was not included in analysis of differential expression with facial symmetry. Masseter muscles are paired jaw muscles (i.e. right and left masseter). In some cases, there was not sufficient quantity/quality of RNA from one side, thus the other side was used. Please note that the following information is provided in the 'source name' field of each sample record; subject ID number; either left or right masseter; J CRANIOFAC SURG_ID# corresponding to the data presented in the manuscript

Project description:IntroductionThe shape and volume of the condyle is considered to play an important role in the pathogenesis of the mandibular deviation. Curvature analysis is informative for objectively assess whether the shape of the condyles matches that of the glenoid fossa. In this study, a three-dimensional (3-D) quantification of bilateral asymmetrical condyles was firstly conducted to identify the specific role of 3-D condylar configuration for mandibular asymmetry.Methods55 adult patients, 26 males (26 ± 5 yrs) and 29 females (26 ± 5 yrs), diagnosed with mandibular asymmetry were included. The examination of deviation of chin point, deviation of dental midlines, inclination of occlusal plane, and depth of the mandibular occlusal plane were conducted. After the clinical investigation, computed tomography images from the patients were used to reconstruct the 3-D mandibular models. Then the condylar volume, surface size, surface curvature and bone mineral density were evaluated independently for each patient on non-deviated and deviated sides of temporomandibular joint.ResultsBoth the condylar surface size and volume were significantly larger on deviated side (surface size: 1666.14 ± 318.3 mm2, volume: 1981.5 ± 418.3 mm3). The anterior slope of the condyle was flatter (0.12 ± 0.06) and the posterior slope (0.39 ± 0.08) was prominently convex on the deviated side. The corresponding bone mineral density values were 523.01 ±118.1 HU and 549.07 ±120. 6 HU on anterior and posterior slopes.ConclusionsThe incongruence presented on the deviated side resulted in a reduction in contact areas and, thus, an increase in contact stresses and changes of bone density. All aforementioned results suggest that the difference existing between deviated and non-deviated condyles correlates with facial asymmetrical development. In mandibular asymmetry patients, the 3-D morphology of condyle on deviated side differ from the non-deviated side, which indicates the association between asymmetrical jaw function and joint remodeling.

Dataset Information

Three-Dimensional Changes in the Mandibular Proximal Segment After Using a Surgery-First Approach in Patients With Class III Malocclusion and Facial Asymmetry.

Abstract

Publications

Three-Dimensional Changes in the Mandibular Proximal Segment After Using a Surgery-First Approach in Patients With Class III Malocclusion and Facial Asymmetry.

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