Changes in temporomandibular joint dysfunction after orthognathic surgery

Author(s): Wolford LM, Reiche-Fischel O, Mehra P


Purpose: We sought to evaluate the effects of orthognathic surgery on temporomandibular joint (TMJ) dysfunction in patients with known presurgical TMJ internal derangement who underwent double-jaw surgery for the treatment of dentofacial deformities.

Patients and methods: Treatment records of 25 patients with magnetic resonance imaging and clinical verification of preoperative TMJ articular disc displacement who underwent double-jaw surgery only were retrospectively evaluated, with an average follow-up of 2.2 years. Signs and symptoms of TMJ dysfunction, including pain, range of mandibular motion, and presence/absence of TMJ sounds, were subjectively (visual analog scales) and objectively evaluated at presurgery (T1), immediately postsurgery (T2), and at longest follow-up (T3). Surgical change (T2-T1) and long-term stability of results (T3-T2) were calculated using the superimposition of lateral cephalometric and tomographic tracings.

Results: Presurgery, 16% of the patients had only TMJ pain, 64% had only TMJ sounds, and 20% had both TMJ pain and sounds. Postsurgery, 24% of the patients had only TMJ pain, 16% had only TMJ sounds, and 60% has both TMJ pain and sounds. Thus, presurgery 36% of the patients had TMJ pain, and postsurgery, 84% had pain. Average visual analog scale pain scores were significantly higher postsurgery and none of the patients with presurgery TMJ pain had relief of pain postsurgery. In addition, 6 patients (24%) developed condylar resorption postsurgically, resulting in the development of Class II open bite malocclusion.

Conclusions: Patients with preexisting TMJ dysfunction undergoing orthognathic surgery, particularly mandibular advancement, are likely to have significant worsening of the TMJ dysfunction postsurgery. TMJ dysfunction must be closely evaluated, treated if necessary, and monitored in the orthognathic surgery patient.

Similar Articles

Three-year stability of open-bite correction by 1-piece maxillary osteotomy

Author(s): Espeland L, Dowling PA, Mobarak KA, Stenvik A

Long-term stability of anterior open-bite closure with bilateral sagittal split osteotomy

Author(s): Fontes AM, Joondeph DR, Bloomquist DS, Greenlee GM, Wallen TR, et al.

Temporomandibular disorders and orthognathic surgery

Author(s): Cascone P, di Paolo C, Leonardi R, Pedullà E

The skeletal stability after maxillo-mandibular osteotomy with a “physiological positioning strategy”

Author(s): Ohba S, Nakao N, Nakatani Y, Kawasaki T, Minamizato T, et al.

Root resorption associated with orthodontic tooth movement: a systematic review

Author(s): Weltman B, Vig KW, Fields HW, Shanker S, Kaizar EE

Root damage and repair in patients with temporary skeletal anchorage devices

Author(s): Ahmed VKS, Rooban T, Krishnaswamy NR, Mani K, Kalladka G

Gummy smile and facial profile correction using miniscrew anchorage

Author(s): Kaku M, Kojima S, Sumi H, Koseki H, Abedini S, et al.

Multiloop edgewise archwire in the treatment of a patient with an anterior open bite and a long face

Author(s): Ribeiro GL, Regis S Jr, da Cunha Tde M, Sabatoski MA, Guariza-Filho O, et al.