Int. J. Oral Maxillofac. Surg.

2018; 47: 613–621

https://doi.org/10.1016/j.ijom.2017.10.014, available online at https://www.sciencedirect.com

Clinical Paper
Orthognathic Surgery

Correlation between B.-J. Choi1, B.-S. Lee1, Y.-D. Kwon1,

J.-W. Lee1, S.-U. Yun2, K.-S. Ryu1,
J.-Y. Ohe1

intraoperative proximal segment

1
Department of Oral and Maxillofacial
Surgery, School of Dentistry, Kyung Hee
University, Seoul, South Korea; 2Yuseong Sun
Hospital, Daejeon, South Korea

rotation and post-sagittal split

ramus osteotomy relapse: a
three-dimensional cone beam
computed tomography study
B.-J. Choi, B.-S. Lee, Y.-D. Kwon, J.-W. Lee, S.-U. Yun, K.-S. Ryu, J.-Y. Ohe:
Correlation between intraoperative proximal segment rotation and post-sagittal split
ramus osteotomy relapse: a three-dimensional cone beam computed tomography
study. Int. J. Oral Maxillofac. Surg. 2018; 47: 613–621. ã 2017 International
Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights
reserved.

Abstract. This study evaluated the effects of proximal segment rotation and the extent of
mandibular setback on post-sagittal split ramus osteotomy (SSRO) relapse using three-
dimensional (3D) analysis. Thirty-one patients diagnosed with a skeletal class III
malocclusion who underwent SSRO alone were enrolled in this study. The movements
of the mandibular condyles were assessed using cone beam computed tomography
(CBCT) and a 3D imaging program at 1 month before the operation (T0), 1 week
after the operation (T1), and 6 months (T2) and 1 year (T3) postoperative. Yaw and roll
were increased at T1 as compared to T0. However, the proximal segments reverted to
their original positions between T2 and T3. There was a positive correlation between
the extent of the posterior movement of the mandible and relapse at 6 months and
1 year postoperative. Although the proximal bone segments showed displacement in
three dimensions at T1, they reverted to their original positions over time. In addition,
Key words: SSRO; condyle position; CBCT;
although there was a positive correlation between the extent of the posterior movement relapse; pitch; yaw; roll movement.
of the mandible and the occurrence of post-surgical relapse at 6 months and 1 year
post-surgery, the rotation of the proximal bone segment during surgery had no Accepted for publication
relationship with postoperative relapse. Available online 13 November 2017

0901-5027/050613 + 09 ã 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
614 Choi et al.
Skeletal class III deformities can result from
either mandibular prognathism or maxillary
deficiency, or the simultaneous occurrence
of both conditions1,2. The sagittal split ra-
mus osteotomy (SSRO) for the correction of
mandibular prognathism was first intro-
duced in the 1950s by Trauner and Obwe-
geser and has been used widely since, as it
enables an intraoral approach and promotes
bone healing by providing a large overlap of
bone segments3–5. Although the SSRO has
been performed for decades, issues regard-
ing postoperative stability and relapse con-
tinue to be raised, with many studies
reporting on these issues.
Studies have reported long-term relapse
rates of between 2.0% and 50.3%, even
when rigid fixation was indicated for
patients with mandibular prognathism
post-orthognathic surgery. Factors affect-
ing post-SSRO stability have been inves-
tigated in many studies. These factors
include the stability of the occlusion due
to preoperative orthodontic treatment, soft
tissue tension around the mandible, the
fixation method for the bone segments,
duration of intermaxillary fixation
(IMF), condyle displacement, a change
in the position of the tongue due to man-
dibular retraction, and the activity of mus-
cles such as the facial muscles,
masticatory muscles, and suprahyoid mus-
cles. Postoperative stability is reported to
depend on the combined result of these
factors6–9.
The exact positioning of the proximal
segment after surgery has also been
reported to be an important contributing
factor to postoperative stability. Komori
et al. reported that skeletal relapse during
the initial IMF was greatly affected by the
surgical method, and that it could be re-
solved by maintaining the position of the
proximal bone segment after surgery10,11.
The position of the proximal bone segment
and the extent of the posterior movement of
the mandible have also been described as
factors affecting post-surgical relapse12–14.
In other studies, condyle displacement due
to the rotation of the proximal bone segment
and the extent of the posterior movement of
the mandible have been reported as factors
contributing to postoperative relapse8,15.
Yang and Hwang reported that the clock-
wise rotation of the proximal bone segment
during surgery was associated with postop-
erative relapse2.
For decades, studies examining the ex-
tent of mandibular setback or the move-
ment of the proximal segment, which
affect postoperative relapse, have used
two-dimensional (2D) radiography tools
such as cephalograms. However, these
studies are limited by the distortion of
the superimposition of the anatomical
structures, such as distortion in the hori-
zontal/vertical plane16.
Three rotational descriptors (pitch, roll,
and yaw) are used to supplement the planar
terms (anteroposterior, transverse, and ver-
tical) in describing the orientation of the line
of occlusion and the aesthetic line of the
dentition17,18. Recent three-dimensional
(3D) reconstructions have greatly contrib-
uted to the understanding of the forward,
backward, transverse, and rotational move-
ments of the distal segment of the mandible.
The complex movements required for the
surgical correction of dentofacial deformi-
ties clearly need to be assessed in 3D to
improve postoperative stability and reduce
symptoms of temporomandibular joint dis-
orders after surgery19,20.
Cone beam computed tomography
(CBCT) is a recently developed technolo-
gy that is used for 3D analyses of the
craniofacial morphology and move-
ment21. The use of this technology is
associated with a lower radiation exposure
and cost as compared to those of conven-
tional computed tomography (CT) or mag-
netic resonance imaging. Many recent
studies have reported that 3D CT analysis
of patients receiving orthognathic surgery
has good reliability and reproducibility22–
24
. reference point on the ramus, three or
This study evaluated the effects of prox-
imal segment rotation and the extent of
mandibular setback on post-SSRO relapse
using 3D analysis.
Materials and methods
Subjects
This prospective study, performed be-
tween January 2011 and December
2014, examined the mandibles of 31
patients who underwent bilateral SSRO
(BSSRO) alone for the correction of skel-
etal class III malocclusion at the Depart-
ment of Oral and Maxillofacial Surgery of
Kyung Hee University Dental Hospital.
The BSSRO was performed by the same
skilled surgeon, using semi-rigid fixation.
The subject group consisted of 14 male
and 17 female patients, who ranged in age
from 18 to 35 years at the time of surgery.
For all subjects, the difference in lateral
movement between the left and right
mandibles was noted to be less than
2 mm. Exclusion criteria included severe
facial asymmetry, congenital malforma-
tions such as cleft lip or cleft palate,
systemic diseases, history of trauma, and
resorption of the mandibular condyle.
During the follow-up period, the
patients did not experience any infections
of the surgical wound, bone fragment
instability, malunion, or malocclusion,
and none of them showed significant re-
lapse requiring revision surgery.
Surgical methods and materials
The BSSRO was performed according to
the Obwegeser–Dal Pont method. With
regard to internal fixation, miniplates
and monocortical screws (Jeil Medical
Corp., Seoul, South Korea) were used
for all subjects. Three screws were used
on each side of the mandible to fix the
miniplate in place. Semi-rigid fixation was
accomplished with a titanium miniplate at
the anterior mandibular ramus.
The proximal segment was placed in the
primary section by measuring three points
from the orthodontic brackets of the max-
illa to a point on the ascending ramus
using a condylar repositioning ruler
(Fig. 1). The distal segment was moved
backwards, and semi-rigid fixation using
one monocortical miniplate and three min-
iscrews per side was conducted after sur-
gery. To prevent displacement of the
proximal segment after mandible move-
ment, the monocortical miniplate was
fixed by maintaining the overlap distance
between the segments. After locating a
more points on the maxillary orthodontic
brackets were measured to this point be-
fore separation, so that the proximal seg-
ment could be fixed in its original location.
Additionally, to prevent condylar dis-
placement caused by bony interferences
between the proximal and distal segments,
an additional vertical osteotomy of the
distal segment or grinding of the bone
interference on the lingual surface of the
proximal segment was performed. To sta-
bilize the postoperative occlusion, approx-
imately 5–7 days of IMF with an inter-
occlusal splint was applied. Physiotherapy
including mouth-opening exercises with
orthodontic elastics was started after re-
leasing the IMF, and was continued for 6
weeks. Postoperative orthodontic treat-
ment was started 6–7 weeks after surgery.
Radiographic examination
The mandibular condyles were assessed
by CBCT in panoramic mode within 1
month before the operation (T0), within
1 week after the operation (T1), and at 6
months (T2) and 1 year (T3) postopera-
tive. The Alphard-Vega 3030 Dental CT
system (Asahi Roentgen Ind. Co., Ltd,
Kyoto, Japan) was used in this study.
The patient’s Frankfort horizontal plane
was set parallel to the floor using a cepha-

Fig. 1. (a) Condylar repositioning ruler. (b) Measurement method for placement of the proximal
segment in the primary position: three points were measured from the orthodontic brackets on
the maxilla to a point on the ascending ramus using the condylar repositioning ruler.
lostat. Tube parameters were specified
(tube voltage of 80 kVp, tube current of
5 mA, and exposure time of 17 s) and the
image was taken in panoramic mode. This
study was approved by the Clinical Re-
search Ethics Committee of Kyung Hee
University Dental Hospital.
Imaging procedure
The CBCT scan data were stored in 0.3-
mm-thick raw DICOM files, and OnDe-
mand3D imaging software (CyberMed
Inc., Seoul, Korea) was used for the 3D
image analysis and multiplanar image re-
construction. All measurements were per-
formed by the same examiner to reduce
human error, and the data collected were
converted into images using OnDe-
mand3D at the different time points: 1
month before surgery (T0), immediately
Proximal segment rotation and post-SSRO relapse
after surgery (T1), 6 months after surgery
(T2), and 1 year (T3) after surgery.
Measurement of posterior movement of the
mandible and post-surgical relapse
3D coordinates (x, y, and z axis values) of
the left and right mental foramina and the
pogonion were measured at the different
time points: 1 month before surgery
(T0), immediately after surgery (T1), 6
months after surgery (T2), and 1 year after
surgery (T3) (Fig. 2).
Three-dimensional aspects of the proximal
segment rotation
The rotations of the left and right proximal
bone segments were measured in 3D:
movement in 3D space, i.e. translation
(forward/backward, right/left, up/down)
was recorded in combination with the
615
rotation about the three perpendicular axes
(horizontal, longitudinal, and vertical)17.
A 3D coordinate system (x, y, z) was
employed to quantify spatial changes in
the condyle position. Spatial changes were
presented in degrees with coordinates to
evaluate the amount (distance, in milli-
metres) and direction (x, y, z) (Fig. 3).
Anatomical points and lines were placed
on the 3D images to define the degree of
surgical change (Figs 4 and 5).
Rotation around the side-to-side axis is
called pitch. Rotation around the front-to-
back axis is called roll. Rotation around
the vertical axis is called yaw. Thus, the
following measurements of the proximal
segment were made in this study: (1)
pitch rotation, i.e. the angle formed by
the Frankfort horizontal plane and the
line connecting the highest point of the
condylar head and the coronoid process;
(2) roll rotation, i.e. the angle formed by
the Frankfort horizontal plane and the
line connecting the outer and inner poles
of the condylar head; (3) yaw rotation, i.e.
the angle formed by the sagittal plane and
the line connecting the highest point of
the condylar head and the coronoid
process.
Statistical analysis
The mean and standard deviation were
calculated for each of the measured values
for each time period. The statistical sig-
nificance of the correlation was deter-
mined by analyzing the extent of the
posterior movement of both the proximal
bone segment and the mandible, and the
post-surgical relapse between 6 months
and 1 year after surgery, using Pearson’s
correlation test at a 95% confidence level.
IBM SPSS Statistics version 20.0 software
(IBM Corp., Armonk, NY, USA) was used
for the statistical analysis.
Results
Three-dimensional movements of the
proximal segment
Yaw and roll were increased immediately
after surgery (T1), as compared to  1
month before surgery (T0). However,
the proximal segments reverted to their
original positions over time (T2–T3)
(Tables 1 and 2).
Relationship between posterior
movement of the mandible and relapse
The average extent of the posterior move-
ment of the mandible was
6.77  4.23 mm, and the average extent
616 Choi et al.

Fig. 2. Superimposition of the pre- and postoperative CT images in the 3D coordinate system. The 3D coordinate system (degrees) shows the
direction and measurement. (a) Frontal view; (b) lateral view.

of relapse at 6 months postoperative was
1.04  1.03 mm (Table 3). There was a
positive correlation between the extent of
the posterior movement of the mandible
and relapse at 6 months and 1 year post-
operative.
Rotation of the proximal segment in
relation to posterior movement of the
mandible
Immediately after surgery, the pitch
movement was observed to decrease with
an increase in the posterior movement of
the mandible. However, This tendency
was reversed at 6 months and 1 year
postoperatively and increased with an in-
crease in the posterior movement of man-
dible. The yaw movement showed a

Fig. 3. Orientation of the proximal segment in three dimensions. Pitch (rotation about the x
axis): proximal direction (+), lateral direction ( ). Roll (rotation about the y axis): clockwise
rotation (+), counter-clockwise rotation ( ). Yaw (rotation about the z axis): medial direction
(+), lateral direction ( ).
negative correlation with the posterior
movement of the mandible only immedi-
ately after surgery (Table 4).
Extent of the relapse at 6 months and
1 year post-surgery and the rotation
pattern of the proximal segment
Correlation between the extent of relapse
at 6 months after surgery and rotation of
the proximal segment was similar to that
observed 1 year post-surgery. Pitch and
roll movements at 6 months and 1 year
after surgery showed positive correlations
with the amount of relapse at 6 months and
1 year post-surgery (Tables 5 and 6).
Fig. 4. Reference points: (1) Cl: outer pole of the condylar head; (2) Cm: inner pole of the
condylar head; (3) Cs: highest point of the condylar head; (4) Cc: highest point of the coronoid
process; (5) Lc: line from Cl to Cm; (6) Ls: line from Cs to Cc.
Proximal segment rotation and post-SSRO relapse
Discussion
Various complications have been reported
following orthognathic surgery for the
improvement of aesthetic and functional
aspects of patients with a skeletal class III
malocclusion, such as relapse, temporo-
mandibular joint dysfunction, and pares-
thesia25. Relapse is an important factor,
not only in terms of aesthetic and func-
tional improvements, but also because
of its association with the success of the
surgery. In particular, BSSRO for setback
of the mandible is known to be associated
with a high tendency to relapse in
patients with a skeletal class III
malocclusion9.
617
Many studies have reported factors that
influence post-SSRO relapse6–8,26. Joss
and Vassalli reported short-term relapse
rates ranging from 1.5% to 32.7% with
bicortical screws, 1.5% to 18.0% with
miniplates, and 10.4% to 17.4% with
absorbable screws, and long-term relapse
rates of 2.0% to 50.3% with bicortical
screws and 1.5% to 8.9% using mini-
plates12.
Van Sickels et al. defined ‘early relapse’
as the tendency to relapse within 6–8
weeks post-surgery, and proposed that this
could be prevented by positioning the
proximal segment in the primary position
during surgery27. However, Mobarak et al.
reported that the rearrangement of the
muscles caused by the clockwise rotation
of the proximal segment, although influ-
encing early postoperative changes, does
not seem to be associated with marked
relapse15.
In this study, 3D CBCT, which results
in less anatomical superimposition and
low distortion, was used to analyze post-
surgical relapse in relation to the rotational
aspect of the proximal segment after
orthognathic surgery. The change in posi-
tion of the proximal segment from its
primary position could be seen in all
dimensions – yaw, pitch, and roll – imme-
diately after surgery. However, a return of
the proximal segment to its primary posi-
tion was observed at 6 months postopera-
tive, and the position of the proximal
segment then stabilized up to 1 year post-
operative. The direction of rotation of the
proximal segment postoperative was ob-
served to vary with the type of movement:
yaw and roll movements tended towards
the proximal side, while pitch tended to-
wards rotation in a clockwise direction.
In this study, 3D CT images were super-
imposed using OnDemand3D based on the
maximum mutual information algo-
rithm28. The accuracy and robustness of
the image fusion method with the use of
this software was investigated in a recent
study using a dry skull model29. After the
attachment of titanium markers to the dry
skulls, image fusion was performed using
OnDemand3D. Image fusion was found
not to be affected by positional change.
The mean error (0.396  0.142 mm) can
be regarded as clinically acceptable in
terms of accuracy for the evaluation of
surgical changes in the proximal segment
rotation by 3D CBCT.
Choi et al. reported an increase in hori-
zontal displacement (intergonion distance
and inter-ramus width) of the proximal
segments after mandibular setback sur-
gery30. The findings of the present study
show a similar post-surgical increase in
618 Choi et al.

Fig. 5. Measurement of the proximal segment rotation (degrees): (a) pitch movement (Pm): angle between the Frankfort horizontal plane and Ls; (
b) roll movement (Rm): angle between the Frankfort horizontal plane and Lc; (c) yaw movement (Ym): angle between the sagittal plane and Ls.
 Proximal segment rotation and post-SSRO relapse 619

Table 1. Average angle of the proximal segment at T0, T1, T2, and T3a; mean  standard horizontal displacement on both sides of
deviation ( ). the proximal segment, due to its tendency
T0 T1 T2 T3 towards proximal rotation during yaw and
Yaw 4.39  3.20 5.47  3.85 5.42  3.86 4.55  2.87 roll movements. Yoo et al. reported no
Pitch 16.03  6.74 15.78  6.55 15.29  6.53 14.78  5.45 significant correlation between the hori-
Roll 7.05  5.47 7.61  5.25 7.10  4.8 6.81  3.91 zontal displacement of the proximal seg-
a
T0: within 1 month before the operation; T1: within 1 week after the operation; T2: 6 months ments and the amount of mandibular
postoperative; T3: 1 year postoperative. setback movement31. In contrast, although
the present study showed no significant
correlation in the amount of mandibular
setback movement and the roll movement
Table 2. Changes in the proximal segmenta; mean  standard deviation ( ). of the proximal segment, the results indi-
T1 T0 T2 T1 T3 T1 cated a positive correlation with yaw
movement, indicating that the horizontal
Yaw 1.76  2.88 0.73  1.87 0.52  0.24
Pitch 1.30  2.18 2.05  1.85 1.24  0.85 displacement of the proximal segment
Roll 0.45  2.45 0.40  2.53 0.20  0.33 could be caused by the yaw movement
a rather than the roll movement of the prox-
T1 T0, T2 T1, and T3 T1 indicate the change between T0 and T1, T2 and T1, and T3
and T1, respectively. Positive values indicate an increase and negative values a decrease. T0: imal segment.
within 1 month before the operation; T1: within 1 week after the operation; T2: 6 months Studies have reported antero-inferior
postoperative; T3: 1 year postoperative. changes in the condylar positions in most
mandibular prognathism patients post-
SSRO32,33. Spitzer and Sitzmann sug-
gested that the anteromedial rotation of
the condyle causes an increase in the
mandibular condyle distance, and that this
Table 3. Relationship between posterior movement of the mandible and relapsea; mean distance increases in correspondence with
 standard deviation (mm). an increase in the retraction of the mandi-
Posterior movement Relapse Pearson correlation coefficientb ble34. The results from the present study
T1 T0 6.77  4.23 confirm this correlation, as a significant
T2 T1 1.04  1.03 0.502** positive correlation was found between
T3 T1 0.98  0.53 0.373** the extent of setback movement of the
a
T0: within 1 month before the operation; T1: within 1 week after the operation; T2: 6 months mandible and the tendency of both the
postoperative; T3: 1 year postoperative. pitch movement to rotate in the clockwise
b
Pearson correlation test: **P < 0.01. direction, and the yaw movement in the
proximal direction. While clockwise rota-
tion of the proximal segment was found to
cause an antero-inferior positional change
of the mandibular condyles attached to the
Table 4. Correlation of rotation of the proximal segment in relation to posterior movement of proximal segments, the rotation of the yaw
the mandiblea; Pearson correlation coefficientb. movement of the proximal segment
T1 T0 T2 T1 T3 T1 caused a positional change of the condyle
Yaw 0.235* 0.037 0.104 in the lateral position. Manipulation of the
Pitch 0.557** 0.212* 0.127* proximal segment during SSRO may
Roll 0.037 0.085 0.102 cause intra-articular oedema and result
a
T0: within 1 month before the operation; T1: within 1 week after the operation; T2: 6 months in inferior displacement of the condyle
postoperative; T3: 1 year postoperative. at an early stage. In the present study,
b
Pearson correlation test: *P < 0.05, **P < 0.01. the condyle tended to move back antero-
superiorly from T1 to T2, representing
recovery towards the preoperative posi-
tion. The reason for this is probably mul-
tifactorial. Postero-inferior displacement
Table 5. Correlation of the extent of the of the condyles may stretch the mastica-
relapse at 6 months post-surgery and the Table 6. Correlation of the extent of the tory muscle and the temporomandibular
rotation pattern of the proximal segmenta; relapse at 1 year post-surgery and the rotation ligament. Hence, this recovery movement
Pearson correlation coefficientb. pattern of the proximal segmenta; Pearson may well be the combined result of mas-
T2 T1 T3 T1 correlation coefficientb. ticatory muscle and ligament stretching,
Yaw 0.142 0.024 T2 T1 T3 T1 resolution of oedema, and removal of the
Pitch 0.557* 0.537* Yaw 0.224 0.104 splint.
Roll 0.217** 0.274** Pitch 0.632* 0.478* Mobarak et al. suggested a relationship
a
T1: within 1 week after the operation; T2: Roll 0.215* 0.117* between the amount of mandibular set-
6 months postoperative; T3: 1 year postoper- a
T1: within 1 week after the operation; T2: back and mandibular relapse, and also
ative. 6 months postoperative; T3: 1 year postoper- between the clockwise rotation of the
b
Pearson correlation test: *P < 0.05, ative. proximal segment and the amount of pos-
**P < 0.01. b
Pearson correlation test: *P < 0.05. terior mandibular movement15. In con-
620 Choi et al.
trast, Lai et al. reported no significant
correlation between the amount of man-
dibular setback and long-term relapse35. In
the present study, the amount of mandib-
ular setback and relapse patterns at T2 and
T3 were found to be positively correlated,
in agreement with the findings of Mobarak
et al. Moreover, as the mandibular setback
movement increased, the pitch movement
of the proximal segment was found to
show a significant increasing relapse ten-
dency at T2 and T3. However, it was
found that the proximal segments had
reverted to their original position at 1 year
post-surgery, thus long-term relapse might
not have a significant correlation with the
amount of the mandibular setback move-
ment.
The pattern of proximal bone rotation
during surgery was not significantly cor-
related with relapse. However, the pitch
movement of the proximal segment at 6
months and 1 year post-surgery showed a
significant positive correlation with re-
lapse. The pitch movement of the proxi-
mal segment showed a clockwise rotation
immediately after the surgery, but a com-
pensatory counter-clockwise rotation was
then observed. In this study, a bent mini-
plate was used intraoperatively to fit the
gap in the mandible, in order to minimize
the displacement of the mandible. This is
thought to have played a role in reducing
the displacement of the proximal segment
postoperatively36.
Lee et al. suggested placing the proxi-
mal segment in its original position using a
preoperatively marked point for reference,
to provide postoperative stability37. In this
study, more than three reference points
were identified on the maxillary orthodon-
tic brackets, and measurements to the
ascending ramus were made before the
osteotomy, in order to be able to place
the proximal segment back in its original
position. This might have been responsi-
ble for the lack of correlation between
postoperative relapse and the rotation pat-
tern of the proximal segment.
The surgical procedure used in the pres-
ent study population was designed to min-
imize the rotation of the proximal segment
that could occur during and after the sur-
gery. However, the proximal segment
showed a tendency to revert to its original
position by rotating counter to the direc-
tion of rotation caused by the surgery. In
particular, the pitch movement showed a
significant positive correlation with re-
lapse after surgery at 6 months and 1 year
postoperative. A positive correlation with
relapse was also observed for the roll
movement, although to a lesser degree
than seen for pitch. These events are
thought to be caused by factors such as
the change in position of the tongue, rear-
rangement of the muscles, tension in the
soft tissue surrounding the mandible, and
scarring caused by surgery, and not by the
rotational aspect of the proximal segment
that occurs during surgery38,39.
In conclusion, this prospective study
was performed to establish the correlation
between proximal segment rotation and
the extent of mandibular setback and
post-SSRO relapse. 3D image analysis
of pre- and postoperative movements of
the proximal bone segments was per-
formed for 31 patients with a skeletal class
III malocclusion. Although the proximal
bone segments showed displacement in
three dimensions during and immediately
after surgery, no clinical symptoms were
observed in the temporomandibular joint
area, and the bone segments reverted to
their original positions over time. In addi-
tion, although there was a positive corre-
lation between the extent of the posterior
movement of the mandible and the occur-
rence of post-surgical relapse at 6 months
and 1 year post-surgery, there was no
relationship between the rotation of the
proximal bone segment during surgery
and postoperative relapse.
Funding
This work was supported by a grant from
Kyung Hee University (20146074).
Competing interests
None declared.
Ethical approval
This study was approved by the Clinical
Research Ethics Committee of Kyung Hee
University Dental Hospital (Institutional
Review Board, IRB – KHD IRB 1411-1).
Patient consent
Not required.
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Address:
Joo-Young Ohe
Department of Oral and Maxillofacial Sur-
gery
School of Dentistry
Kyung Hee University
130-702 Seoul
Republic of Korea
Tel.: +82 2 958 9440
fax: +82 2 966 4572
E-mail: ojyoung81@gmail.com