Assessment of condylar changes after orthognathic surgery using computed tomography regional superimposition

Abstract

This study aimed to investigate the effects of bimaxillary advancement orthognathic surgery on the condylar remodeling of the temporomandibular joint (TMJ) using voxel-based regional superimposition of cone-beam computed tomography (CBCT). In this retrospective study, the sample comprised 56 condyles from 28 healthy patients (aged from 16 to 50years) with mandibular retrognathism treated with bimaxillary advancement. CBCT scans were taken preoperatively and at 14.3±4.2months postoperatively. The scans at the two time points were superimposed using regional voxel-based registration to assess condylar changes in the follow-up period. The linear alterations were measured in six different areas of each condyle to determine the pattern of condylar remodeling. Although no significant correlation was observed between changes in condylar surfaces, bone resorption occurred predominantly in the posterior and superior regions, while bone formation was predominantly on the anterior surface. Medial and lateral surfaces presented fewer bone changes. The overall bone changes were smaller than 1mm bilaterally in 21 patients (75%) and, considering each condyle individually, were smaller than 1mm in 48 condyles (85.7%). The results suggested that mild condylar remodeling in healthy patients is a common finding after orthognathic surgery. Future studies may clarify the mechanisms involved in the remodeling and help to understand the reasons for the remodeling pattern.

Keywords: 3D image registration; CBCT superimposition; cone-beam CT; orthognathic surgery.