Symmetry is an essential component for balance and function in the craniofacial complex. A precise diagnosis of asymmetric craniofacial structures is crucial for determining treatment approaches (Baek et al., 2007; You et al., 2018). Maxillomandibular asymmetry can arise from variations in mandibular corpus length, mandibular ramus and/or condylar height, or rotational positioning of the maxilla and/or mandible. Dentoalveolar structures have the capacity to adapt to maxillomandibular asymmetry to maintain masticatory function. However, skeletal asymmetry can lead to adjustments in the muscular system to compensate for functionality, resulting in muscular system dysfunctions and alterations in skeletal structures (Rodrigues et al., 2009; Fong et al., 2010).

Orthognathic surgery, widely utilized for correcting dentoalveolar and skeletal malocclusions, improving facial aesthetics, and alleviate airway problems and temporomandibular disorders (TMDs). However, there is concern about potential complications including clinically symptomatic TMDs, especially, condylar resorption after orthognathic surgery (Wolford, 2000).

The effects of orthognathic surgery on the temporomandibular joint (TMJ) have been widely studied. A primary concern is its potential impact on postoperative stability and clinical outcomes, due to the remodeling and resorption processes observed in the condyles (Gulcek et al., 2023). Condylar remodeling refers to the physiological balance between bone resorption and formation, which enables the TMJ to adapt to new functional demands. However, when these changes exceed the condyle's natural capacity for adaptation, remodeling may transition into condylar resorption. This resorptive process leads to a reduction in condylar volume and mass and results in an irreversible, progressive deterioration in condylar morphology (He et al., 2019).

Several studies have documented changes in condylar position and TMJ morphology following mandibular osteotomies. However, these alterations have not been associated with TMJ dysfunction (Hoppenreijs et al., 1998; Katsumata et al., 2006).

Long-term radiographic assessments have identified condylar remodeling subsequent to orthognathic surgery (Eckerdal et al., 1986), with some studies exploring the physiological remodeling of mandibular condyle heads using CBCT images (Wolford, 2000; Katsumata et al., 2006; Ha et al., 2013).

Understanding and addressing potential condylar displacements through segmentation and regional superimposition of CBCT images is of paramount importance in the field of oral and maxillofacial surgery. This methodology not only enables a comprehensive evaluation of condylar remodeling within the region but also facilitates a range of detailed analyses including microanalysis of bone trabecular structure in asymmetric structures (Schilling et al., 2014; Koerich et al., 2016).

The primary objective of this study was to assess dimensional and volumetric changes in mandibular condyles of patients with maxillomandibular asymmetry who underwent mandibular osteotomy or double jaw surgery, utilizing CBCT data. Specifically, the study aimed to analyze parameters commonly employed in μCT measurements, such as condylar resorption and structural alterations in trabecular bone morphology using CBCT data, based on the correction of asymmetry and rotational movements in orthognathic surgeries for patients with maxillomandibular asymmetry. Furthermore, the study compared these changes in patients with asymmetry (study group) to those who underwent sagittal correction only, with no rotational correction in the yaw (z) axis or any dental or menton asymmetry. This latter group served as the control for the study.