Background/Objectives: Mandibular counterclockwise (CCW) autorotation following maxillary repositioning is a common biomechanical consequence of bimaxillary orthognathic surgery. However, its effect on temporomandibular joint (TMJ) morphology remains controversial. This study aimed to evaluate whether condyle-centered CCW mandibular autorotation influences postoperative TMJ spaces and condylar morphology using cone-beam computed tomography (CBCT). Methods: A total of 24 patients who underwent combined Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were included in this retrospective analysis. Patients were divided into two groups based on virtual surgical planning: those with condyle-centered CCW autorotation (4–7°) and those without autorotation. Preoperative and one-year postoperative CBCT images were analyzed. Sagittal and coronal joint spaces, condylar dimensions, and glenoid fossa thickness were measured. Intra- and intergroup comparisons were performed using nonparametric statistical tests (α = 0.05). Results: Both groups demonstrated significant postoperative reductions in condylar height, width, and depth, reflecting adaptive bone remodeling. Joint space changes were limited overall. A significant intergroup difference was observed only in the change in the right superior joint space (p = 0.024), which decreased in the non-autorotation group but was preserved or slightly increased in the autorotation group. No other joint space or fossa parameter showed significant between-group differences. Conclusions: Condyle-centered CCW mandibular autorotation during bimaxillary orthognathic surgery does not induce adverse TMJ morphological changes beyond physiological adaptation. Preservation of the superior joint space suggests that autorotation may contribute to maintaining a more favorable condyle–fossa relationship. Incorporating controlled mandibular autorotation into surgical planning may support TMJ biomechanical balance and postoperative joint stability.

Background/Objectives: Virtual surgical planning (VSP) allows three-dimensional assessment of complex dentofacial deformities and has become integral to modern orthognathic surgery. However, evidence remains limited regarding how skeletal characteristics and malocclusion patterns translate into surgical movement selection. This study aimed to evaluate demographic features, skeletal malocclusion patterns, and clinical treatment strategies in patients undergoing VSP-guided orthognathic surgery. Methods: This retrospective study included 158 patients who underwent VSP-assisted orthognathic surgery between 2019 and 2025. Sagittal skeletal classification, vertical growth pattern, facial asymmetry, and maxillary crossbite were evaluated together with planned maxillary and mandibular movements. Surgical procedures were analyzed according to skeletal malocclusion classes (Class I, II, and III). Group comparisons were performed using chi-square and Kruskal–Wallis tests. Multivariable logistic regression analysis was conducted to assess factors associated with bimaxillary surgery (p < 0.05). Results: Skeletal Class I malocclusion was most prevalent (46.8%), followed by Class III (29.7%) and Class II (23.4%). Hyperdivergent growth patterns were predominantly observed in Class II patients, whereas normodivergent patterns were most common in Class III cases (p < 0.05). Mandibular advancement and setback generally followed expected class-based trends but were also observed across non-corresponding skeletal classes. Maxillary impaction and mandibular autorotation were frequently incorporated. Bimaxillary surgery was performed in 84.2% of cases. Logistic regression analysis showed no independent predictors of bimaxillary surgery (p > 0.05). Conclusions: VSP-assisted orthognathic surgery demonstrates that surgical planning cannot be reduced to sagittal skeletal classification alone. Treatment decisions are shaped by combined sagittal, vertical, transverse, and patient-specific factors, supporting a multidimensional and individualized planning approach.

Background/Objectives: Le Fort I osteotomy is a widely performed surgical procedure for correcting maxillary deformities, but it carries the risk of rare complications, including nasolacrimal duct (NLD) injury. This study evaluated the anatomical relationship between the nasolacrimal canal (NLC) and the maxilla across different skeletal patterns via cone-beam computed tomography (CBCT) to define safer zones for fixation during orthognathic surgery. Methods: This retrospective study included 76 patients (152 canals) scheduled for orthognathic surgery. The participants were classified into retrognathic, orthognathic, and prognathic groups based on SNA values. Four linear distances were measured on sagittal CBCT sections: from the superior (SL), middle (ML), and inferior (IL) points of the NLD to the anterior maxillary border and from the canine apex to the inferior NLC point (IC). A total of 608 measurements were analyzed via ANOVA, the Kruskal–Wallis test, and post hoc tests, with significance set at p < 0.05. Results: The ML distance was significantly greater in the prognathic group than in the retrognathic and orthognathic groups (p < 0.001). The IL distance was significantly shorter in retrognathic individuals (p < 0.001). No significant differences were found in SL (p = 0.063) or IC (p = 0.141) among the groups. Conclusions: The proximity of the NLC to the maxilla varies according to the skeletal pattern. The retrognathic maxilla results in shorter IL distances, suggesting increased risk during fixation, whereas the prognathic maxilla results in greater ML distances. Preoperative CBCT-based individualized evaluation is recommended to optimize fixation and reduce NLD injury risk in Le Fort I osteotomy.

Background/Objectives: The aim of this study is to evaluate pretreatment osseous changes in the temporomandibular joint (TMJ) in orthognathic surgery patients using cone-beam computed tomography (CBCT) and to determine the distribution of the findings according to sagittal skeletal malocclusion groups. Methods: CBCT images of 103 patients (206 condyles) were retrospectively analyzed. Patients were classified as Class I, II, and III based on ANB angles. Condylar morphology was assessed for flattening, sclerosis, erosion, osteophyte formation, and subchondral bone cysts. All evaluations were performed by a single investigator (κ = 0.87). Group differences were analyzed using the chi-square test with Bonferroni correction (p < 0.05). Results: The most frequent alteration was flattening (29.6%), followed by sclerosis (11.2%), erosion (10.7%), osteophyte formation (8.3%), and subchondral bone cysts (4.4%). No significant sex-related differences were found (p > 0.05). A significant difference was observed only in sclerosis (p = 0.049), which was more prevalent in Class I than Class III. Flattening predominated in all groups, while erosion and osteophytes were more common in Class II, and sclerosis was more frequent in Class I. Conclusions: This study demonstrated that condylar flattening was the most common morphological alteration in orthognathic patients across all skeletal malocclusion groups. The higher prevalence of sclerosis in Class I compared with Class III suggests that mandibular positioning may influence adaptive and degenerative remodeling processes of the TMJ. This study emphasizes the importance of CBCT evaluation for detecting osseous changes in TMJ before orthognathic surgery and demonstrates that pre-existing alterations may impact surgical stability and postoperative functional outcomes.

To evaluate postoperative adaptive changes in the mandibular condyle after bimaxillary orthognathic surgery in skeletal Class III patients and compare these changes according to mandibular fixation type. Twenty-six patients treated with Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were divided into semirigid and rigid fixation groups. Preoperative and 1-year postoperative CBCT images were analyzed. Condylar trabecular microstructure was assessed by three-dimensional fractal analysis, and cortical bone thickness was measured in five regions. Baseline cephalometric variables, cortical thickness, and fractal dimension values were similar between groups. The semirigid group showed increased medial and decreased superior cortical thickness, while the rigid group showed no significant cortical changes. Fractal dimension values remained stable in both groups. Intergroup comparison showed a significant difference only in superior cortical thickness change. Fixation type did not markedly affect condylar trabecular microstructure, although superior cortical remodeling may differ by fixation method.

To compare temporomandibular disorder (TMDs) knowledge and clinical attitudes between orthodontists and oral and maxillofacial surgeons (OMFS). This cross-sectional study included 160 participants (80 per specialty) in Türkiye. A 41-item online questionnaire assessed knowledge across four domains and clinical attitudes. Responses were compared with expert reference rates and between specialties. Both groups showed substantial knowledge deficiencies, particularly in pathophysiology and chronic pain. OMFS demonstrated significantly higher correct-response rates than orthodontists across multiple items in all four knowledge domains, whereas orthodontists performed better on one pathophysiology item. Clinical attitudes were generally positive; OMFS more frequently supported patient information and counseling, while orthodontists more frequently favored referral of suspected TMD cases. Despite positive clinical attitudes, important TMD knowledge gaps persist in both specialties, with OMFS showing greater overall knowledge. Postgraduate education should reinforce evidence-based, diagnosis-driven, and biopsychosocial TMD management.