Jin Hoo Park

Recovery pattern of mandibular movement by active physical therapy after bilateral transoral vertical ramus osteotomy.

PURPOSE The purpose of the present study was to evaluate the effect of an active physical therapy (PT) protocol after transoral vertical ramus osteotomy and to investigate the rehabilitation patterns of mandibular movement. MATERIALS AND METHODS The study included 187 patients diagnosed with mandibular prognathism with or without facial asymmetry who had undergone bilateral transoral vertical ramus osteotomy from 2001 to 2009. The subjects were evaluated preoperatively and 1, 3, 6, 12, 18, and 24 months postoperatively in terms of the periods of PT and range of mandibular movement. The data were analyzed using 1-way analysis of variance (significance level, P < .05). RESULTS Of the 187 patients, 108 (57.8%) did not receive repeat intermaxillary fixation (IMF) during the PT period, 58 (31.0%) received it once, 15 (8.0%) twice, and 6 patients more than 3 times. The average PT period for all was 10.9 days (range 5 to 45). The mean maximal mouth opening was 50.7 mm before surgery, decreasing to 33.9 mm at 1 month postoperatively. This was followed by an increase to 46.3 mm at 6 months postoperatively, with the maximal mouth opening thereafter showing 93.9% to 95.7% recovery compared with the preoperative state. CONCLUSIONS About 88% of the patients with transoral vertical ramus osteotomy responded well to the reduced IMF duration and active PT protocols, receiving repeat IMF less than twice. It required about 6 months to recover 90% of the preoperative maximal mouth opening and 12 months to recover near preoperative levels statistically. The benefits of reduced IMF duration and the PT protocols seem to promote rehabilitation of the masticatory muscles and prevention of mandibular hypomobility.

Anatomical study of the location of the antilingula, lingula, and mandibular foramen for vertical ramus osteotomy

BackgroundThe purpose of this study was to identify the location of the antilingula, lingula, and mandibular foramen in Korean cadavers and to promote safe and accurate surgery without damage to the inferior alveolar neurovascular bundle (IANB) when performing a vertical ramus osteotomy (VRO).MethodsThis study was conducted on the dried mandibles of 20 adult cadavers. Digital calipers were used to measure the distances from the anatomical reference points (antilingula, lingula, and mandibular foramen).ResultThe antilingula was located at the anterior 44% and superior 31% in the ramus. The lingula was located at the anterior 55% and superior 30% in the ramus. The mandibular foramen was located at the anterior 58% and superior 46% in the ramus. Regarding the positional relationship with the antilingula, the lingula was located 0.54 mm superior and 4.19 mm posterior, and the mandibular foramen was located 6.95 mm inferior and 4.98 mm posterior. The results suggested that in order to prevent damage to the IANB, osteotomy should be performed in the posterior region of ramus at least 29% of the total horizontal length of the ramus.ConclusionUsing only the antilingula as a reference point is not guaranteed to IANB injury. However, it is still important as a helpful reference point for the surgeon in the surgical field.