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Imaging of Orthognathic,

9

Maxillofacial,

and Temporomandibular

Joint Surgery

Daniel Thomas Ginat, Per-Lennart A. Westesson,

and Russell Reid

9.1\ Vertical Ramus Osteotomy

9.1.1\ Discussion

Intraoral vertical ramus osteotomy is a treatment option for mandibular prognathism. In this technique, a vertically oriented cut made in the mandibular ramus allows the mandibular ramus to be lengthened and the temporomandibular­

joint disc to recapture (Fig. 9.1). The procedure­ yields satisfactory results and has fewer complications­ than intra-articular techniques. Expected changes following vertical ramus osteotomy that can be appreciated on imaging include cortical bone thickening, narrowing of the bone marrow space, medial tilting of the mandibular condyle, and masticator muscle atrophy (Fig. 9.2).

D.T. Ginat, M.D., M.S. (*)

Department of Radiology, University of Chicago, Chicago, IL, USA

e-mail: dtg1@uchicago.edu

P.-L. A. Westesson, M.D., Ph.D., D.D.S.

Division of Neuroradiology, University of Rochester Medical Center, Rochester, NY, USA

R. Reid, M.D., Ph.D.

Department of Surgery, University of Chicago, Chicago, IL, USA

© Springer International Publishing Switzerland 2017

421

D.T. Ginat, P.-L.A. Westesson (eds.), Atlas of Postsurgical Neuroradiology,

DOI 10.1007/978-3-319-52341-5_9

422

D.T. Ginat et al.

 

 

a

b

Fig. 9.1  Vertical ramus osteotomy. The patient has a history of temporomandibular joint disc dysfunction. Panorex (a) and lateral radiograph (b) show a unilateral left mandibular ramus vertical osteotomy (arrows)

Fig. 9.2  Muscle atrophy after vertical ramus osteotomy. Axial CT image shows mildly decreased bulk of the masticator­ muscles on the right (arrow), ipsilateral to where vertical ramus osteotomy was performed