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: 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.

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.

Background/Objectives: Variation in the mandibular canal and surrounding bone may affect surgical risk during sagittal split ramus osteotomy (SSRO). This study examined whether canal position and bone morphology at SSRO-relevant sites differ according to mandibular sagittal position. Methods: This retrospective cone-beam computed tomography study included 72 adults classified as retrognathic, normal, or prognathic according to the SNB angle. Bilateral measurements from 144 mandibular canals were obtained at the mandibular foramen entrance, ramus–corpus transition, and mesial aspect of the second molar. Cortical and cancellous bone thicknesses, canal diameter, and canal-to-cortex distances were compared using one-way analysis of variance with Tukey’s post hoc test. Repeated measurements showed high reproducibility, with intraclass correlation coefficients exceeding 0.90. Results: At the mandibular foramen entrance, retrognathic patients had greater fusion of the buccal and lingual cortices-to-foramen and buccal cortex-to-canal distances than normal patients (both p < 0.05). Lingual cortical bone at the ramus–corpus transition was also thicker in the retrognathic group (p = 0.006). At the second molar level, the prognathic group showed greater buccal, lingual, and inferior cortical thicknesses but lower buccal cancellous bone thickness (all p < 0.05). Mandibular canal diameter did not differ significantly among the groups. Conclusions: Mandibular sagittal position was associated with regional differences in the bone surrounding the mandibular canal. Lower buccal cancellous bone thickness in prognathic patients may indicate less bony separation between the canal and the surgical field. These findings may inform patient-specific CBCT assessment and SSRO planning, although their relationship with surgical complications requires prospective clinical validation.

Background: Preoperative patient education is an essential component of orthognathic surgery. This study aimed to compare short-term changes in anxiety following separate orthodontic and surgical information consultations in patients scheduled for orthognathic surgery. Methods: This prospective observational study included 27 patients scheduled for bimaxillary orthognathic surgery. Participants attended standardized information consultations with an orthodontist and, approximately two weeks later, an oral and maxillofacial surgeon. Anxiety was assessed using the State–Trait Anxiety Inventory (STAI) and a visual analog scale (VAS). Trait anxiety (STAI-T) was assessed at baseline, state anxiety (STAI-S) was measured after each consultation, and VAS scores were recorded immediately before and after both consultations. The primary outcome was the within-participant difference between surgical and orthodontic VAS changes, analyzed using the Wilcoxon signed-rank test. Secondary comparisons were adjusted using the Holm method. Results: The mean age was 23.44 ± 5.20 years, and 59.3% of participants were female. VAS scores did not change significantly following orthodontic consultation (3.59 vs. 3.56; p = 0.891), whereas they increased significantly following surgical consultation (3.96 vs. 5.93; p < 0.001). The mean VAS changes were −0.04 ± 1.06 and 1.96 ± 1.29, respectively. The direct comparison of these changes demonstrated a significant difference between consultations (mean paired difference: 2.00 ± 1.59; p < 0.001). The mean baseline STAI-T score was 45.07 ± 5.89. Post-consultation STAI-S scores were higher after surgical than orthodontic consultation (46.96 ± 4.86 vs. 43.85 ± 6.24; p = 0.008; Holm-adjusted p = 0.015). Conclusions: VAS anxiety scores remained unchanged following orthodontic consultation but increased after surgical consultation, with a significant difference between the within-session changes. However, the fixed consultation sequence and proximity of the surgical consultation to the operation prevent causal attribution of these differences to consultation type. These findings support consideration of patients’ psychological responses throughout multidisciplinary preoperative care.