Stability of the condylar position
Stable condylar position applies to presurgical assessment, surgical control of the proximal segment, and the patient’s postsurgical adaptation to the new neuromuscular and functional environment. In the early postsurgical stage of recovery, patients are frequently concerned about the lack of mobility of the mandible. In 2014, Ueki et al.122 assessed the border movements of the mandible following Class III surgical correction. Their sample consisted of 73 patients; 41 underwent a sagittal split ramus osteotomy (SSRO), and 32 had SSRO and a Le Fort I osteotomy. For 52 of the patients, mandibular movements were measured with the Myotronics measurement system before and then 6 months after surgery. For 21 of the patients, the measurements were delayed for 18 months. Based on the findings of this paper, patients who had mandibular setback with or without a Le Fort I procedure did have hypomobility at the 6-month measurement stage. However, those evaluated after 18 months demonstrated that the measured border movements returned to pretreatment levels.
A second important consideration related to surgical orthodontic outcomes is the long-term stability of the patient’s condyle. Gunson et al.57 have described the condition of idiopathic female condylar resorption, which may be responsible for late condylar changes (e.g., cheerleader’s syndrome, avascular necrosis, or condylosis). These findings led the authors to hypothesize that some women are prone to condylar resorption that occurs after increased joint load and may be related to oral contraceptive pill use, which is well tolerated by most women
Neuromuscular adaptation
The surgical procedures that change the skeletal structures also change long-standing neuromuscular patterns of the stomatognathic system; achieving a balance or an equilibrium of the skeletal structures, dental structures, and muscles is the ultimate biologic challenge for the orthognathic team. Although the procedures performed today are based scientifically on a variety of working hypotheses, the relapse problems that still occur are reminders that some of the treatment provided may have empirical components.
p717
이 글은 네이버 블로그에서 가져온 글입니다. 원문: blog.naver.com/surgeon
답글 남기기