Assessment of skeletal stability of intraoral vertical ramus osteotomy with one-day maxillary–mandibular fixation followed by early jaw exercise

Abstract

Purpose: Intraoral vertical ramus osteotomy (IVRO) is an effective surgical technique for cases of mandibular setback, and is simpler and has a lower incidence of mentalis paresthesia compared to sagittal split ramus osteotomy (SSRO), another well-known orthognathic surgical technique for the mandible. However, IVRO has a disadvantage in the prolonged duration of postoperative maxilla-mandibular fixation (MMF) required due to the absence of rigid bone fixation. To avoid an extended MMF period, we developed a postoperative management protocol for our IVRO patients, which includes jaw exercises with elastic bands starting on the second day after surgery.Methods: We evaluated the cephalometric skeletal and dental stabilities of 16 IVRO patients as they followed our protocol.Results: The stabilities were confirmed and were similar to those of previous reports.Conclusion: One-day MMF and early initiation of jaw exercise after IVRO did not affect the jaw position stability. Moreover, our findings suggest that starting jaw exercise earlier after IVRO surgery is beneficial, as it allows patients to avoid a long period of rigid MMF so that they can resume their normal daily activities sooner.

Complications associated with orthognathic surgery

“…Therefore, it is necessary to develop a standardized diagnostic standard and classification method for TMD through systematic and well-designed research56. The following are the most mutually agreed upon opinions among scholars57585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103.…”

“…3) Orthognathic surgery can improve or worsen the existing temporomandibular joint symptoms, or may not result in any changes at all8999100101102103.…”

Orthognathic surgery and temporomandibular joint symptoms

“…A drawback of IVRO is the requirement of IMF since internal rigid fixation is not performed, and some clinicians recommend more than 4 weeks of IMF postoperatively [ 91 - 94 ]. However, active physical therapy with less than 2 weeks of IMF demonstrated a stable occlusion and good bone healing [ 95 ], (Table 4 ) Some study reported just one-day of IMF followed by early jaw exercise being sufficient [ 96 ]. When initial bite is unstable, an active physical therapy with close follow-ups, and re-IMF protocol is used to obtain improved occlusion, and 88% of patients achieve a stable occlusion after IVRO within 10 days of active physical therapy and Maximum mouth opening (MMO) more than 30 mm [ 95 ].…”

Short lingual osteotomy without fixation: a new strategy for mandibular osteotomy known as “physiological positioning”

“…10,11 Almost 90% of the artery runs just inside the mandible ramus outside the lateral pterygoid muscle in Japanese people, whereas more than 45% of the artery runs inside the pterygoid muscle in Westerners. 12 Hence, we adopted the SLO technique, in which osteotomy sites are directly visible, unlike IVRO.…”