Three-dimensional quantitative assessment of surgical stability and condylar displacement changes after counterclockwise maxillomandibular advancement surgery: Effect of simultaneous articular disc repositioning

Am J Orthod Dentofacial Orthop. 2018 Aug;154(2):221-233. doi: 10.1016/j.ajodo.2017.10.030.


Introduction: In this study, we quantitatively assessed 3-dimensional condylar displacement during counterclockwise maxillomandibular advancement surgery (CMMA) with or without articular disc repositioning, focusing on surgical stability in the follow-up period.

Methods: The 79 patients treated with CMMA had cone-beam computed tomography scans taken before surgery, immediately after surgery, and, on average, 15 months postsurgery. We divided the 142 condyles into 3 groups: group 1 (n = 105), condyles of patients diagnosed with symptomatic presurgical temporomandibular joint articular disc displacement who had articular disc repositioning concomitantly with CMMA; group 2 (n = 23), condyles of patients with clinical verification of presurgical articular disc displacement who had only CMMA; and group 3 (n = 14), condyles of patients with healthy temporomandibular joints who had CMMA. Presurgical and postsurgical 3-dimensional models were superimposed using voxel-based registration on the cranial base. Three-dimensional cephalometrics and shape correspondence were applied to assess surgical and postsurgical displacement changes.

Results: Immediately after surgery, the condyles moved mostly backward and medially and experienced lateral yaw, medial roll, and upward pitch in the 3 groups. Condyles in group 1 showed downward displacement, whereas the condyles moved upward in groups 2 and 3 (P ≤0.001). Although condylar displacement changes occurred in the 3 groups, the overall surgical procedure appeared to be fairly stable, particularly for groups 1 and 3. Group 2 had the greatest amount of relapse (P ≤0.05).

Conclusions: CMMA has been shown to be a stable procedure for patients with healthy temporomandibular joints and for those who had simultaneous articular disc repositioning surgery.

MeSH terms

  • Adolescent
  • Adult
  • Cone-Beam Computed Tomography*
  • Female
  • Humans
  • Imaging, Three-Dimensional*
  • Joint Dislocations / diagnostic imaging*
  • Joint Dislocations / surgery
  • Male
  • Mandibular Advancement / methods*
  • Mandibular Condyle / diagnostic imaging*
  • Maxilla / surgery*
  • Middle Aged
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Temporomandibular Joint Disc / diagnostic imaging*
  • Temporomandibular Joint Disc / surgery
  • Young Adult