Effect of Pterygomasseteric sling shortening via mandibular angle resection on postoperative skeletal stability in skeletal class III malocclusions treated with mandibular setback surgery

IF 1.8 Q3 SURGERY

JPRAS Open Pub Date : 2026-07-01 Epub Date: 2026-05-23 DOI:10.1016/j.jpra.2026.05.035

Le Tan Hung, Pham Trinh Quoc Khanh, Le Duc Lanh, Tran Ai Khiem, Nguyen My Huyen, Vo Ke Dat

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引用次数: 0

Abstract

Postoperative skeletal stability issues are frequently attributed to the tension exerted by the pterygomasseteric muscle sling following mandibular setback. This study investigated the hypothesis that simultaneous mandibular angle resection during Bilateral Sagittal Split Ramus Osteotomy (BSSRO) enhances skeletal stability by reducing this muscular tension.

A prospective randomised controlled study was conducted on 20 patients with Skeletal Class III malocclusion - characterised by mandibular prognathism. The study sample was equally divided into an experimental group (4 males, 6 females; mean age 23.6 ± 3.9 years) undergoing the combined procedure (BSSRO with simultaneous mandibular angle ostectomy), and a control group (5 males, 5 females; mean age 20.4 ± 3.4 years) receiving isolated ramus osteotomy (conventional BSSRO setback only). Lateral cephalometric tracings were utilised to quantify the horizontal and vertical positional changes of the mental region, specifically at Point B, Pogonion and Menton, during the 3-month postsurgical healing phase.

The results indicated a significant divergence in remodelling between the two groups. The control group characterised anterior relapse (B: +1.35 ± 1.50 mm; Pog: +0.81 ± 2.92 mm), whereas the experimental group demonstrated a stabilising posterior settling effect (Point B: -1.44 ± 1.93 mm; Pog: -1.14 ± 4.06 mm).

These findings substantiate that resecting the mandibular angle effectively shortens the pterygomasseteric sling, thereby alleviating the muscular tension responsible for skeletal rebound. Consequently, simultaneous angle ostectomy during Surgery-First Orthognathic Approach (SFOA) mandibular setback protocol is advocated not merely as an aesthetic contouring procedure for lower facial width reduction, but as a functional release of the pterygomasseteric sling that significantly improves early skeletal stability, suggesting a larger study with Class II malocclusions as well or other types of skeletal deformity

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下颌骨退缩手术治疗III类骨错咬合后，经下颌骨角切除翼状肱骨干吊带缩短对术后骨骼稳定性的影响。

术后骨骼稳定性问题通常归因于下颌骨后退后翼肱肌悬吊所施加的张力。本研究探讨了在双侧矢状裂支截骨术（BSSRO）中同时切除下颌角通过减少这种肌肉紧张来增强骨骼稳定性的假设。一项前瞻性随机对照研究对20例以下颌前突为特征的骨骼III类错颌合患者进行了研究。研究样本平均分为实验组（男性4人，女性6人，平均年龄23.6±3.9岁），采用联合手术（BSSRO联合下颌角截骨），对照组（男性5人，女性5人，平均年龄20.4±3.4岁），采用分离支截骨（仅采用常规BSSRO后退）。在术后3个月的愈合阶段，利用侧位测量图来量化心理区域的水平和垂直位置变化，特别是在B点、Pogonion和Menton。结果表明，两组之间的重塑存在显著差异。对照组表现为前路复发（B点：+1.35±1.50 mm; Pog: +0.81±2.92 mm），而实验组表现出稳定后路沉淀的效果（B点：-1.44±1.93 mm; Pog: -1.14±4.06 mm）。这些发现证实，切除下颌角有效地缩短了翼肱骨干悬吊，从而减轻了引起骨骼反弹的肌肉紧张。因此，在手术-第一正颌入路（SFOA）下颌后退方案中，同时进行角度骨切除术不仅是一种减少下面部宽度的美学整形手术，而且是一种功能释放翼骨肌吊带的方法，可以显着改善早期骨骼稳定性，这表明需要对II类错咬合或其他类型的骨骼畸形进行更大规模的研究。

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来源期刊

JPRAS Open Medicine-Surgery

CiteScore

1.60

自引率

0.00%

发文量

审稿时长

22 weeks

期刊介绍： JPRAS Open is an international, open access journal dedicated to publishing case reports, short communications, and full-length articles. JPRAS Open will provide the most current source of information and references in plastic, reconstructive & aesthetic surgery. The Journal is based on the continued need to improve surgical care by providing highlights in general reconstructive surgery; cleft lip, palate and craniofacial surgery; head and neck surgery; skin cancer; breast surgery; hand surgery; lower limb trauma; burns; and aesthetic surgery. The Journal will provide authors with fast publication times.