Evaluating fractal value of mandibular ramus and condylar volume in patients undergoing orthognathic surgery: a systematic review and meta-analysis.

Aim: The aim of the present study was to evaluate condylar volume and mandibular ramus in patients undergoing orthognathic surgery.

Method: Relevant keywords were searched in the international databases Cochrane, Embase, and MEDLINE up to February 2025. Study selection criteria were based on the PICOS strategy; randomized clinical trial studies, cohort studies, cross-sectional studies, case-control studies (study (S)) that examined changes in condylar and ramus position (Outcome (O)) in orthognathic surgery as skeletal treatment (Intervention (I)) for Class III versus Class II (Comparison (C)) in patients who had undergone orthognathic surgery (Population (P)). Data were collected based on study findings from three-dimensional (3D) cephalometric/cone-beam computed tomographic (CBCT)analysis and measurements of condylar angle, volume, and position. The methodological index for non-randomized studies (MINORS) used to determine the quality of the studies. Mean differences were used as an effect size with fixed-effects model and inverse-variance methods of 95% confidence intervals (CI). Meta-analysis was performed using Stata (as of version 17).

Result: The mean differences in condylar height between Class II and Class III were 2.19 mm (MD 2.19 mm 95% CI; 1.32 mm, 3.96 mm; p < 0.05). The mean differences in ramus angle between Class II and Class III were - 0.02° (MD - 0.02 95% CI - 0.06, 0.03; p > 0.05).

Conclusion: Based on the meta-analysis of the present study, orthognathic surgery did not significantly affect the microstructure of the mandibular ramus in the correction of class III malocclusions. In Class II, the condyle height was significantly reduced after orthognathic surgery, while the condyle width did not change.

Trial registration: PROSPERO CRD420251054773.