Oral and maxillofacial surgery
A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review

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It is very important to clarify the relationship between a dentofacial structure and a temporomandibular joint (TMJ) structure in orthognathic surgery. Recently, it was reported that the skeletal and occlusal patterns were associated with the TMJ morphology, including the disk position. In orthognathic surgery, some surgeons state that alterations in the condylar position from surgery can lead to malocclusion associated with the risk of early relapse, and also favor the development of temporomandibular disorders. For these reasons, several positioning devices have been proposed and applied, but now there is no scientific evidence to support the use of condylar positioning devices. There are some reasons why scientific evidence cannot be obtained; however, it also includes the question of whether the preoperative position of the condyle is the desired postoperative position. The purpose of this study was to verify the desired condylar position in orthognathic surgery, based on literature on the postoperative condylar position in orthognathic surgery. From the studies reviewed, it was suggested that the preoperative position of the condyle was not the desired postoperative position in orthognathic surgery.

Section snippets

Disk position

Disk displacement is a common abnormality seen in images of the TMJ. Usually the displacement is anterior, anterior lateral, or anterior medial. In the normal joint, the posterior band of the biconcave disk is located superior to the condyle in the closed-mouth position.11, 12, 13, 14, 15 Normal disk position has been defined in previous studies without reference to the skeletal pattern and occlusion16, 17; however, images different from those for normal joint categories have been recognized in

Conclusions

Most surgeons rely on manual repositioning after sagittal split osteotomy to obtain the best mandibular proximal segment relationship with the condylar fossa. In repositioning the proximal segment, skilled surgeons feel the degree and direction of stress on the proximal segment and remember the data of the condylar position experienced previously. Recently, application of 3D CT for orthognathic surgical planning, especially the function of 3D virtual osteotomy, has been presented.99, 100, 101,

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