Kohei Marukawa

Horizontal changes in the condylar head after sagittal split ramus osteotomy with bent plate fixation

OBJECTIVEnThe purpose of this study was to evaluate the horizontal changes in the condylar head with bent plate fixation after sagittal split ramus osteotomy (SSRO) with and without a Le Fort I osteotomy.nnnSTUDY DESIGNnOf 47 Japanese patients with mandibular prognathism, 24 underwent SSRO and 23 underwent SSRO in combination with a Le Fort I osteotomy. A 3-5-mm gap was made between the proximal and distal segments, and a bent plate was fixed with 4 screws in each side of the mandible. The angle of the condylar long axis, as well as the anteroposterior and mediolateral displacement of the condylar head were assessed preoperatively and postoperatively by computerized tomography (CT).nnnRESULTSnThere was no significant difference in reduction in mandibular length between SSRO alone and SSRO with Le Fort I on the axial view of a 3-dimensional CT. There were no significant differences between pre- and postoperative horizontal changes in the condylar long axis or in the anteroposterior and mediolateral displacement of the condylar head, although the length of the proximal segment in SSRO with Le Fort I osteotomy was significantly shorter than in SSRO alone (P < .05).nnnCONCLUSIONnThese results suggest that the use of a bent plate for SSRO does not change preoperative angle or position significantly in setback surgery, regardless of the addition of Le Fort I osteotomy.

Statin-induced bone morphogenetic protein (BMP) 2 expression during bone regeneration: an immunohistochemical study.

OBJECTIVESnThe purpose of this study was to investigate bone morphogenetic protein (BMP) 2 expression after implantation of a statin and recombinant human BMP-2 (rhBMP-2) and to compare the bone regeneration capability of these substances in the rabbit nasal bone using immunohistologic methods.nnnSTUDY DESIGNnTwelve adult male Japanese white rabbits (n = 12; age 12-16 weeks, weight 2.5-3.0 kg) were divided into 3 experimental groups and 1 control group. A total of 48 bone defects, 4 per rabbit, were created in the nasal bone while preserving the nasal membrane. In the experimental groups, 1 group was implanted with 10 mg of a statin dissolved in 0.2 mL water with an atelocollagen sponge (ACS); the second group was implanted with 5 microg rhBMP-2 with an ACS; and in the third group only the ACS was implanted. No material was implanted in the control group. Animals were killed at 1, 2, and 4 weeks after surgery. The parts that had been operated on were removed and prepared for histologic assessment. The expression of BMP-2 was evaluated using immunohistochemistry, and double-immunostaining for BMP-2 and Ki-67 was observed by fluorescent microscopy.nnnRESULTSnNo significant differences were observed between the statin/ACS group and rhBMP-2/ACS group at 1, 2, and 4 weeks after surgery. The number of cells which stained positively for BMP-2 increased significantly in both of the implanted groups compared with the control group (P < .0001). The positive fluorescent double-immunostaining for BMP-2 and Ki-67 was similar in both implanted groups.nnnCONCLUSIONnThis study suggests that statin/ACS implants show BMP-2 expression and osteoinductive activity that is similar to those of rhBMP-2/ACS implants.

Evaluation of Bone Formation After Sagittal Split Ramus Osteotomy With Bent Plate Fixation Using Computed Tomography

PURPOSEnTo evaluate bone formation between the proximal and distal segments after a sagittal split ramus osteotomy (SSRO) with bent plate fixation.nnnPATIENTS AND METHODSnThe subjects were 23 patients (46 sides) who underwent bilateral SSRO setback surgery. They were divided into titanium and absorbable plate groups. A 3 to 7-mm gap was made between the proximal and distal segments and a bent plate was fixed with 4 screws in each side of the mandible. The square of ramus (RmS), the anteroposterior length (RmA-RmP), and the mediolateral width (RmM-RmL) of the ramus at the horizontal plane under the mandibular foramen were assessed preoperatively, immediately after surgery, and 1 year postoperatively by computed tomography (CT).nnnRESULTSnThere were no significant differences between the titanium and absorbable plate groups over time. RmS after 1 year was larger than preoperatively in both groups (P < .0001). RmA-RmP significantly increased immediately after surgery and significantly decreased after 1 year in both groups (P < .0001). RmA-RmP after 1 year was significantly larger than the preoperative value in both groups (P < .0001). RmM-RmL showed a similar tendency to the anteroposterior length, but was not significant.nnnCONCLUSIONSnThe gap between the proximal and distal segments can fill with new bone after SSRO with both titanium and absorbable plates, even with few bony contacts between segments.

Assessment of the Relationship Between the Recovery of Maximum Mandibular Opening and the Maxillomandibular Fixation Period After Orthognathic Surgery

PURPOSEnThe purpose of this study was to evaluate the differences in the recovery of maximum mandibular opening (MMO), and the relationship between MMO and the maxillomandibular fixation (MMF) period after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO), with and without Le Fort I osteotomy.nnnPATIENTS AND METHODSnSixty-eight patients with diagnosed mandibular prognathism with or without asymmetry were divided into 4 groups (SSRO, IVRO, SSRO with Le Fort I osteotomy, and IVRO with Le Fort I osteotomy). MMO and the MMF period were measured preoperatively and at 1, 3, 6, 12, and 18 months after surgery. The differences among surgical procedures and the relationship between MMO and the MMF period were examined statistically.nnnRESULTSnIn relation to time-dependent changes in MMO, there were no significant differences among the groups. There were significant positive correlations between MMO and the MMF period from 1 month to 6 months after surgery. However, there were no significant correlations at 12 and 18 months after surgery.nnnCONCLUSIONnThis study suggests that there were no significant differences between single-jaw surgery and double-jaw surgery in terms of postoperative time-dependent changes in the recovery of MMO. However, the MMF period was associated with the recovery of MMO.

Assessment of ramus, condyle, masseter muscle, and occlusal force before and after sagittal split ramus osteotomy in patients with mandibular prognathism.

PURPOSEnThe purpose of this study was to examine the relationship between the morphologies of the masseter muscle and the ramus and occlusal force before and after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism.nnnPATIENTS AND METHODSnThe study group consisted of 26 patients with mandibular prognathism. All patients underwent bilateral SSRO as well as 3-dimensional computed tomography on which the masseter muscle, ramus, and condyle were measured preoperatively and at 1 year postoperation. Occlusal force and contact area were also recorded with pressure-sensitive sheets.nnnRESULTSnIn the cross-sectional area of the masseter muscle, there were no significant differences between the pre- and postoperative status. However, postoperative ramus width and area were significantly larger than preoperative values (P < .0001). Postoperative right condylar area was significantly larger than the preoperative value (P = .0120). Occlusal force and contact area 1 year after surgery were significantly larger than the preoperative values (P = .0016, P = .0190).nnnCONCLUSIONnThis study suggested that the masseter muscle area did not significantly differ from preoperative status 1 year after SSRO, although occlusal force, contact area, and ramus area and width increased significantly 1 year after SSRO.

The effects of changing position and angle of the proximal segment after intraoral vertical ramus osteotomy

The authors evaluated changes in position and angle of the proximal segment, including the condyle, after intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy to verify whether displacement of the proximal segment could induce postoperative complications. Changes in condylar angle, ramus angle, and displacement of proximal segment were measured pre- and postoperatively. The position of the temporomandibular joint (TMJ) disc was examined pre- and postoperatively. Trigeminal nerve hypoesthesia in the lower lip was assessed bilaterally. The postoperative horizontal condylar angle was significantly smaller than the preoperative one on the deviated and non-deviated sides (P<0.0001). The postoperative coronal condylar angle was significantly larger than the preoperative one on the deviated side (P=0.0483). The postoperative sagittal ramus angle was larger than the preoperative one on the deviated (P<0.0001) and non-deviated (P=0.00005) side. Most joints with an anteriorly-displaced disc with and without reduction improved on the non-deviated side; 5 of 16 joints improved on the deviated side. Results suggest the position and angle of the proximal segment, including the condyle, could change after IVRO. This could be associated with symptomatic improvement in TMJ, and extreme medial displacement of the proximal segment could delay recovery from lower lip hypoesthesia.

Skeletal Stability After Mandibular Setback Surgery: Bicortical Fixation Using a 2.0-mm Locking Plate System Versus Monocortical Fixation Using a Nonlocking Plate System

PURPOSEnThis study was conducted to compare the time-course changes in condylar long-axis and skeletal stability after sagittal split ramus osteotomy (SSRO) with bicortical plate fixation versus monocortical plate fixation.nnnPATIENTS AND METHODSnOf a group of 40 Japanese patients diagnosed with mandibular prognathism, 20 underwent SSRO with bicortical plate fixation using a locking plate system and the other 20 underwent SSRO with monocortical plate fixation using a conventional plate system. The time-course changes in condylar long-axis and skeletal stability were assessed through axial, frontal, and lateral cephalograms.nnnRESULTSnSignificant differences were found between the 2 groups in changes of the left condylar angle between the initial and 1-month measurements (P = .0454) and in ANB between the 1- and 3-month measurements (P = .0206); however, no significant differences were found between the 2 groups in the other measurements in each time interval.nnnCONCLUSIONSnOur findings suggest no significant differences in postoperative time-course changes between bicortical plate fixation using a locking plate system and monocortical plate fixation using a conventional plate system.

An experimental study of use of absorbable plate in combination with self-setting α-tricalcium phosphate for orthognathic surgery

OBJECTIVEnThe purpose of this study was to histologically and immunohistochemically evaluate bone formation using both self-setting α-tricalcium phosphate (α-TCP; Biopex) and absorbable plate (Super Fixsorb-MX) in rabbit cranium bone.nnnSTUDY DESIGNnTwelve adult male Japanese white rabbits (12-16 wk, 2.5-3.0 kg) were used. The surgical defects were made in the nasal bone of a rabbit, and Biopex was implanted in the left side and no material in the right side. Two-hole absorbable plate and 2 screws (Super Fixsorb-MX) were fixed across the defect in each side. The rabbits were killed at 1, 4, 12, and 24 weeks after surgery, and formalin-fixed specimens were embedded in acrylic resin. The specimens were stained with hematoxylin and eosin. For immunohistochemical analysis, the specimens were treated with bone morphogenetic protein 2 (BMP-2) antibodies. Finally, these were evaluated microscopically.nnnRESULTSnNew bone formation was observed in the region of absorbable plate and nasal membrane after >4 weeks. The area of new bone with Biopex was significantly larger than that of the control side after 1, 4, and 12 weeks (P < .05). The number of BMP-2-stained cells in the experimental side was significantly larger than in the control side after 4 and 12 weeks (P < .05).nnnCONCLUSIONnThis study suggests that the use of absorbable plate (Super Fixsorb-MX) in combination with Biopex could be useful and that both of Super Fixsorb-MX and Biopex could provide adequate bone regeneration.

The evaluation of surgical factors related to recovery period of upper lip hypoaesthesia after Le Fort I osteotomy

PURPOSEnIt is unclear whether surgical factors can affect the upper lip sensitivity. The aim of this study was to assess the factors that can affect the recovery period of hypoaesthesia of the upper lip after Le Fort I osteotomy, using trigeminal somatosensory evoked potential (TSEP) objectively.nnnPATIENTS AND METHODSnTwenty-nine patients with mandibular prognathism underwent Le Fort I osteotomy with and without artificial pterygoid plate fracture. Trigeminal nerve hypoaesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The distance between the infraorbital foramen and the osteotomy line (IO) or the nearest plate/screw position (IP) was measured on three-dimensional computed tomography (CT). The relationship between the recovery period in upper lip hypoaesthesia and surgical factors (these distances, movement amount, pterygoid plate fracture) were analysed statistically.nnnRESULTSnThe recovery period in upper lip hypoaesthesia did not significantly correlate with IO, IP and movement amount. There was no significant difference between pterygoid plate fracture group and non-fracture group.nnnCONCLUSIONnTemporary hypoaesthesia of upper lip after Le Fort I osteotomy could not be avoided, however, osteotomy line, plate/screw position and pterygoid plate fracture in Le Fort I osteotomy did not affect the recovery period of upper lip hypoaesthesia with TSEP.