Condylar sag
•Download as PPTX, PDF•
54 likes•12,676 views
Condylar sag as a complication of orthognathic surgery
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Condylar sag
Similar to Condylar sag (20)
More from Sapna Vadera
More from Sapna Vadera (11)
Recently uploaded
Recently uploaded (20)
Condylar sag
- 1. CONDYLAR SAG Dept. of Oral & Maxillofacial Surgery, VSPM’s DCRC, Nagpur
- 2. • Introduction • Definition • Incidence of Condylar Sag • Risk factors • Condylar Sag & IVRO • Types • Intra-operative diagnosis • Prevention of Condylar sag- IVRO, BSSO, Lefort-I Osteotomy • Articles at a glance • Conclusion CONTENTS
- 3. INTRODUCTION Malocclusion after orthognathic surgeries (BSSO, IVRO, lefort I osteotomy) may be the result of failure of rigid fixation at the osteotomy site, occlusal shifts during fixation or improper condylar position.
- 4. • Condylar sag is most challenging to diagnose and treat correctly. The most troublesome sequelae are skeletal instability and anteroinferior condyle displacement (sag) with resultant unpredictability of the postoperative mandibular position. • The term condylar sag was coined by Hall et al. in 1975. • They described the influence of the condylar position on postoperative occlusal stability following the release of IMF. Hall HD, Chase DC, Payor LG. Evaluation and refinement of the intraoral vertical subcondylarosteotomy. J Oral Surg1975;33:333-41. INTRODUCTION
- 5. Condylar sag can be defined as an immediate or late change in position of the condyle in the glenoid fossa after surgical establishment of a preplanned occlusion and rigid fixation of the bone fragments, leading to a change in the occlusion. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 DEFINITION
- 6. • Complications following Orthognathic surgery ranges from 9.7-24.5 % • Neural deficit- most common – 50.42% • TMJ Dysfunction- 13.64% • Hemorrhage-9.09%
- 7. • Incorrect vector during condylar positioning; • An incomplete or green-stick split that prevents condylar seating; • Muscular, ligamentous, or periosteal interference; • Intra-articular hemorrhage or edema and flexing the proximal segment while placing rigid fixation. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 RISK FACTORS
- 8. • Condylar sag after IVRO has clinical significance and is associated with improved mandibular function. • Removal of masseter & medial pterygoid attachment Condylar luxation (lateral pterygoid muscle pulling the condyle forward)
- 9. 2 postulates • Medial and forward displacement of the mandibular disk- by the upper head of the lateral pterygoid muscle. • After sectioning - the mandibular condyle is displaced in the same direction as the disk - by the pull of the lower head of the lateral pterygoid muscle.
- 10. Condylar Sag Central Unilateral Bilateral Peripheral Type I Type II TYPES Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- 11. CENTRAL CONDYLAR SAG Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- 12. PERIPHERAL CONDYLAR SAG - I Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- 13. PERIPHERAL CONDYLAR SAG - II Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- 14. INTRA-OPERATIVE DIAGNOSIS OF CONDYLAR SAG Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- 15. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 CENTRAL CONDYLAR SAG
- 16. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 CENTRAL CONDYLAR SAG
- 17. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 PERIPHERAL CONDYLAR SAG - II
- 18. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 PERIPHERAL CONDYLAR SAG - II
- 22. Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292 CONDYLAR SAG – LEFORT-I OSTEOTOMY
- 25. Meticulous examination of the occlusion and an understanding of the occlusal changes secondary to condylar sag can reliably identify condylar sag intraoperatively. The use of suitable corrective measures during the primary operation can substantially reduce the postoperative complication rate of condylar sag. CONCLUSION
- 26. REFERENCES • Massimo Politi et al, Intraoperative Awakening of the Patient During Orthognathic Surgery: A Method to Prevent the Condylar Sag, J Oral Maxillofac Surg 65:109-114, 2007 • Arnett G Wiliam, A redefinition of bilateral sagittal osteotomy advancement relapse, American Journal of Orthodontics and Dentofacial Orthopedics 1993;104:506-15 • Kensuke Yamauchi et all, Condylar luxation following bilateral intraoral vertical ramus osteotomy,Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:747-51 • Eckerdal 0, Sund G. Astrand P: Skeletal remodeling in the temporomandibular joint after oblique sliding osteotomy of the mandibular rami. Int J Oral Maxillofac Surg 15:233, 1986 • Kenneth S Rotskoff et al, correction of condylar displacement following IVRO,JOMS, 49, 366-372, 1991 • Hall HD, Chase DC, Payor LG. Evaluation and refinement of the intra-oral vertical subcondylar osteotomy. Oral Surg 1975;33:333–341. • Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- 27. THANK YOU…..
Editor's Notes
- Dept. of OMFS,VSPM’s DCRC, Nagpur
- The need to accurately position the condyle in the glenoid fossa has been underlined by the increasingly common application of rigid fixation in BSSO. Failure of which will lead to condylar sag
- Generally, the condyle was located in an anterior and inferior position within the glenoid fossa. following surgical procedure and with the use of training elastics, the condyle was gradually reseated in a centric relationship. 5 Condylar sag is a frequent finding after an IVRO. Immediately following surgical procedure, the condyles are positioned inferiorly and anteriorly within the glenoid fossa. During the postoperative follow-up period, superior and posterior repositioning of the condyle occur gradually. This condylar sag after IVRO has clinical significance and is associated with improved mandibular function. Campbell developed 2 postulates to explain displacement following condylotomy. In the first, medial and forward displacement of the mandibular disk is brought about by the pull of the upper head of the external pterygoid muscle. Second, after sectioning, the mandibular condyle is displaced in the same direction as the disk by the pull of the lower head of the external pterygoid muscle.
- Johan. P. Reyneke, C. Ferretti, Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy ,British Journal of Oral and Maxillofacial Surgery (2002) 40, 285–292
- Factors that may mimic Condylar Sag Intra-operatively Mobility of the osteotomy site Shift of Occlusion during placement of rigid fixation.
- Medial pterygoid stripping limit To minimize postoperative condylar sag after IVRO, Hall et al (1975) recommended limited stripping of the medial pterygoid muscle attachment, explaining that an osteotomy that was too near the posterior border of the vertical ramus would leave a small mass of muscle attached to the proximal segment, which might result in more sag.
- PROCEDURES THAT RESULT IN LENGTHENING OF THE SOFT TISSUE ENVELOPE quired to assure condylar seating. As noted, procedures that result in lengthening of the soft tissue envelope of the ramus, such as vertical lengthening of the maxillomandibular complex, can result in condylar sag. a poorly designed vertical ramus osteotomy with a short proximal segment and/or if the extent of setback leaves insufficient medial pterygoid attachment, condylar sag and even condylar subluxation may result.4e6 In these situations, some form of internal fixation should be considered.
- training elastics- centric relationship following surgical procedure and with the use of training elastics, the condyle was gradually reseated in a centric relationship.
- Muscle tone, muscular activity, and proprioception appear to have important roles in the clinical evidence of a postoperative malocclusion during the intraoperative awakening; they can reliably implement the accuracy of the diagnosis of condylar sag, and they can favor its correction.