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Lekroengsin B, Tachiki C, Takaki T, Nishii Y. Relationship between Changes in Condylar Morphology and Masticatory Muscle Volume after Skeletal Class II Surgery. J Clin Med 2023; 12:4875. [PMID: 37510990 PMCID: PMC10381303 DOI: 10.3390/jcm12144875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
The treatment of dentofacial deformities generally includes orthognathic surgery in which mandibular condyle changes following surgery are a common cause of relapse. This study investigated the changes in the mandibular condyle and related muscles to identify the factors that affected the changes in the mandibular condyle after orthognathic surgery in skeletal class II patients. This research studied 60 joints in 30 patients with skeletal class II dentofacial deformities who received surgical orthodontic treatment, including bilateral sagittal split ramus osteotomy, and underwent computed tomography before and after orthodontic treatment. The mandibular condyle, masseter, and medial pterygoid muscles were reconstructed and measured in 3D. Condylar positional and morphology changes, masseter and medial pterygoid muscle volume, temporomandibular joint (TMJ) pain, and distal segment movement were analyzed. The study observed that both the masseter and medial pterygoid muscle volumes decreased with statistical significance. The changes in the horizontal direction were positively correlated with the amount of movement. The findings indicated that mandibular condyle changes were significantly affected by the movement of the distal segment, the medial pterygoid muscle volume, and the direction of the distal segment, which influenced the treatment's long-term stability after orthognathic surgery.
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Affiliation(s)
| | - Chie Tachiki
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Takashi Takaki
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo 101-0061, Japan
| | - Yasushi Nishii
- Department of Orthodontics, Tokyo Dental College, Tokyo 101-0061, Japan
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Cifter ED. Effects of Occlusal Plane Inclination on the Temporomandibular Joint Stress Distribution: A Three-Dimensional Finite Element Analysis. Int J Clin Pract 2022; 2022:2171049. [PMID: 36101811 PMCID: PMC9463010 DOI: 10.1155/2022/2171049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sudden changes in masticatory loads and occlusal conditions contribute to temporomandibular disorders. Clockwise (CW) or counterclockwise (CCW) rotation of the occlusal plane is one of the factors that alter the direction of the occlusal forces transmitted to the temporomandibular joint structures. Finite element analysis was used to identify possible regions of high stress in the temporomandibular joint. MATERIALS AND METHODS A computer-aided design model of a symmetrical edentulous maxillomandibular bony complex with a temporomandibular joint was manually generated using Rhinoceros 4.0 freeform modeling software. Three-dimensional discrete mesh generation was performed using VRMesh Studio. The reference occlusal plane angle was accepted as 8° in the sagittal plane, and by modifying 4° in the CW and CCW directions, CW and CCW models were obtained, respectively. The present study aimed to evaluate the changes in stress distribution in the condylar cartilage and temporomandibular disc using the von Mises and maximum-minimum principal stress evaluations of three different occlusal plane inclinations. The null hypothesis of this three-dimensional finite element analysis was that "occlusal plane inclination does not change the stress distribution on the temporomandibular joint structures." RESULTS The compressive stress on the condyle increased with CW rotation of the occlusal plane. The von Mises equivalent stress of the temporomandibular disc shifted to the medial, posterior, and superior directions after CW and CCW rotations of the occlusal plane. The CW rotation of the occlusal plane increased the von Mises equivalent.
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Affiliation(s)
- Ebru Demet Cifter
- Istanbul University Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey
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Ramanathan M, Kiruba GA, Christabel A, Parameswaran A, Kapoor S, Sailer HF. Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes. J Maxillofac Oral Surg 2020; 19:477-489. [PMID: 33071493 DOI: 10.1007/s12663-020-01414-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction The popularity and interest evoked by orthognathic surgery and distraction osteogenesis are undisputed in the field of oral and maxillofacial surgery. However, questions regarding the individual identities of either of them with clarity in their concepts, techniques and outcomes have remained unanswered. The aim of this review is to shed light on these questions. Methods This review is structured as a narrative review of thirty years of literature available in the specialities of orthognathic surgery and distraction osteogenesis. Conclusion The authors present a review of existing literature combined with contrasting experience gained over the years in providing an overview of the merits and demerits of the two surgical techniques which will aid the clinician in justifying the use of one technique over the other.
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Affiliation(s)
- Manikandhan Ramanathan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | - Godwin Alex Kiruba
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | | | | | - Sanjanaa Kapoor
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
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de Souza Tesch R, Takamori ER, Menezes K, Carias RBV, Dutra CLM, de Freitas Aguiar M, Torraca TSDS, Senegaglia AC, Rebelatto CLK, Daga DR, Brofman PRS, Borojevic R. Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report. Stem Cell Res Ther 2018; 9:94. [PMID: 29625584 PMCID: PMC5889586 DOI: 10.1186/s13287-018-0806-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/12/2018] [Accepted: 02/13/2018] [Indexed: 01/22/2023] Open
Abstract
Background Upon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions. Methods We propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography. Results The cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form. Conclusions We propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being followed by inclusion of new patients with a similar pathological profile to complete an ongoing stage I/II study. Trial registration This clinical trial is approved by the National Commission of Ethics in Medical Research (CONEP), Brazil, CAAE 12484813.0.0000.5245, and retrospectively registered in the Brazilian National Clinical Trials Registry and in the USA Clinical Trials Registry under the Universal Trial Number (UTN) U1111–1194-6997. Electronic supplementary material The online version of this article (10.1186/s13287-018-0806-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ricardo de Souza Tesch
- Centro de Medicina Regenerativa, Faculdade de Medicina de Petrópolis - FASE, Avenida Barão do Rio Branco 1003, Centro, Petrópolis, RJ 25680-120, Brazil.
| | - Esther Rieko Takamori
- Centro de Medicina Regenerativa, Faculdade de Medicina de Petrópolis - FASE, Avenida Barão do Rio Branco 1003, Centro, Petrópolis, RJ 25680-120, Brazil
| | - Karla Menezes
- Centro de Medicina Regenerativa, Faculdade de Medicina de Petrópolis - FASE, Avenida Barão do Rio Branco 1003, Centro, Petrópolis, RJ 25680-120, Brazil
| | - Rosana Bizon Vieira Carias
- Centro de Medicina Regenerativa, Faculdade de Medicina de Petrópolis - FASE, Avenida Barão do Rio Branco 1003, Centro, Petrópolis, RJ 25680-120, Brazil
| | - Cláudio Leonardo Milione Dutra
- Centro de Medicina Regenerativa, Faculdade de Medicina de Petrópolis - FASE, Avenida Barão do Rio Branco 1003, Centro, Petrópolis, RJ 25680-120, Brazil
| | - Marcelo de Freitas Aguiar
- Instituto de Saúde de Nova Friburgo, Universidade Federal Fluminense, Rua Dr. Silvio Henrique Braune 22, Nova Friburgo, RJ 28625-650, Brazil
| | - Tânia Salgado de Sousa Torraca
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Avenida Pedro Calmon, 550 - Cidade Universitária, Rio de Janeiro, RJ 21941-901, Brazil
| | - Alexandra Cristina Senegaglia
- Centro de Tecnologia Celular, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Bairro Prado Velho, Curitiba, PR 80215-901, Brazil
| | - Cármen Lúcia Kuniyoshi Rebelatto
- Centro de Tecnologia Celular, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Bairro Prado Velho, Curitiba, PR 80215-901, Brazil
| | - Debora Regina Daga
- Centro de Tecnologia Celular, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Bairro Prado Velho, Curitiba, PR 80215-901, Brazil
| | - Paulo Roberto Slud Brofman
- Centro de Tecnologia Celular, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Bairro Prado Velho, Curitiba, PR 80215-901, Brazil
| | - Radovan Borojevic
- Centro de Medicina Regenerativa, Faculdade de Medicina de Petrópolis - FASE, Avenida Barão do Rio Branco 1003, Centro, Petrópolis, RJ 25680-120, Brazil
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Cottrell DA, Farrell B, Ferrer-Nuin L, Ratner S. Surgical Correction of Maxillofacial Skeletal Deformities. J Oral Maxillofac Surg 2017; 75:e94-e125. [DOI: 10.1016/j.joms.2017.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Te Veldhuis EC, Te Veldhuis AH, Bramer WM, Wolvius EB, Koudstaal MJ. The effect of orthognathic surgery on the temporomandibular joint and oral function: a systematic review. Int J Oral Maxillofac Surg 2017; 46:554-563. [PMID: 28174061 DOI: 10.1016/j.ijom.2017.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/12/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The objective of this systematic review was to examine the effect of orthognathic surgery (OS) on the temporomandibular joint and oral function. Electronic databases were systematically searched for studies published until October 2015. Articles were assessed against predefined inclusion criteria. The included papers were divided into four groups based on the type of OS performed. The following items were recorded: quality of evidence using the Oxford Centre for Evidence-Based medicine (CEBM) criteria, number of patients, presence/absence of controls, mean age at treatment, follow-up time, clinical examination findings, bite force, use of the Helkimo Index and Research Diagnostic Criteria for Temporomandibular Disorders, imaging findings, and patient questionnaire results. A total of 4669 articles were identified; 76 relevant articles were included in the review. These studies assessed a total 3399 patients and 380 controls, with a mean age of 25.4 years. The great variety of OS techniques, examination techniques, diagnostic criteria, and imaging techniques used in the articles studied, as well as the quality of the study designs, made it difficult to compare studies and to draw conclusions. However, looking at the different aspects studied in general, it can be stated that OS seems to have little or no harmful effect on the TMJ and oral function (level of evidence: levels II, III, and IV).
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Affiliation(s)
- E C Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands.
| | - A H Te Veldhuis
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus MC - University Medical Centre Rotterdam, The Netherlands
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Assessment of skeletal stability after counterclockwise rotation of the maxillomandibular complex in patients with long-face pattern subjected to orthognathic surgery. J Craniofac Surg 2015; 25:432-6. [PMID: 24531245 DOI: 10.1097/scs.0000000000000395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the long-term skeletal stability of counterclockwise maxillomandibular complex rotation in patients undergoing orthognathic surgery for long-face pattern. METHODS This retrospective study consisted of 10 patients who underwent the procedure between September 2002 and April 2008. To assess the skeletal stability, 30 preoperative (T1), recent postoperative (T2), and late postoperative (T3) cephalometric radiographs of the 10 patients were digitized and traced. To measure the stability in the occlusal plane and mandibular plane, the cephalometric points and planes were determined 3 times. RESULTS In the long term, on average, the A-point moved 0.21 mm backward (AYT3-AYT2), the B-point moved 0.57 mm backward (BYT3-BYT2), and the posterior nasal spine moved 0.31 mm backward (PNSYT3-PNSYT2). On average, the anterior maxillary area (A-point) moved 0.14 mm downward (AXT3-AXT2), the mandible (B-point) moved 0.07 mm downward (BXT3-BXT2), and the posterior nasal spine moved approximately 0.18 mm upward (PNSXT3-PNSXT2). The occlusal plane increased by 0.75 degrees (OPT3-OPT2), and the mandibular plane increased by 0.45 degrees (MPT3-MPT2). CONCLUSIONS It was observed that the counterclockwise rotation of the maxillomandibular complex produces stable results in patients with long-face pattern undergoing orthognathic surgery.
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9
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Valladares-Neto J, Cevidanes LH, Rocha WC, Almeida GDA, Paiva JBD, Rino-Neto J. TMJ response to mandibular advancement surgery: an overview of risk factors. J Appl Oral Sci 2014; 22:2-14. [PMID: 24626243 PMCID: PMC3908759 DOI: 10.1590/1678-775720130056] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022] Open
Abstract
Objective In order to understand the conflicting information on temporomandibular joint
(TMJ) pathophysiologic responses after mandibular advancement surgery, an overview
of the literature was proposed with a focus on certain risk factors. Methods A literature search was carried out in the Cochrane, PubMed, Scopus and Web of
Science databases in the period from January 1980 through March 2013. Various
combinations of keywords related to TMJ changes [disc displacement, arthralgia,
condylar resorption (CR)] and aspects of surgical intervention (fixation
technique, amount of advancement) were used. A hand search of these papers was
also carried out to identify additional articles. Results A total of 148 articles were considered for this overview and, although
methodological troubles were common, this review identified relevant findings
which the practitioner can take into consideration during treatment planning: 1-
Surgery was unable to influence TMJ with preexisting displaced disc and crepitus;
2- Clicking and arthralgia were not predictable after surgery, although there was
greater likelihood of improvement rather than deterioration; 3- The amount of
mandibular advancement and counterclockwise rotation, and the rigidity of the
fixation technique seemed to influence TMJ position and health; 4- The risk of CR
increased, especially in identified high-risk cases. Conclusions Young adult females with mandibular retrognathism and increased mandibular plane
angle are susceptible to painful TMJ, and are subject to less improvement after
surgery and prone to CR. Furthermore, thorough evidenced-based studies are
required to understand the response of the TMJ after mandibular advancement
surgery.
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Affiliation(s)
- José Valladares-Neto
- Federal University of Goiás, School of Dentistry, Department of Orthodontics, GoiâniaGO, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Lucia Helena Cevidanes
- University of Michigan, School of Dentistry, Department of Orthodontics, Ann Arbor, USA, Department of Orthodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Wesley Cabral Rocha
- General Hospital of Goiânia, Department of Oral and Maxillofacial Surgery, GoiâniaGO, Brazil, Department of Oral and Maxillofacial Surgery, General Hospital of Goiânia, Goiânia, GO, Brazil
| | - Guilherme de Araújo Almeida
- Federal University of Uberlândia, School of Dentistry, Department of Orthodontics, UberlândiaMG, Brazil, Department of Orthodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - João Batista de Paiva
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - José Rino-Neto
- University of São Paulo, School of Dentistry, Department of Orthodontics, São PauloSP, Brazil, Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Cottrell DA, Edwards SP, Gotcher JE. Surgical correction of maxillofacial skeletal deformities. J Oral Maxillofac Surg 2013; 70:e107-36. [PMID: 23127998 DOI: 10.1016/j.joms.2012.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
The authors of this study propose a new informed consent form for orthognathic surgery. In a previous study from 2004, a careful review of the international literature and clinical practice suggested the feasibility of dividing the informed consent form into 2 parts, one describing diagnostic procedures and therapeutic/surgical times, and another describing possible problems. During these 4 years, we noticed that this model has 2 setbacks. We replaced point 2, "temporomandibular joint disorders," with "postoperative temporomandibular joint derangement," so that the surgeon is now supposed to inform the patient on the possibility of condylar dislocations, condylar sag, and clockwise/anticlockwise rotations of occlusal surface after surgery. We also changed point 5, "tooth and periodontal disease," in "tooth damage, avulsion, and periodontal disease" because we believe patients should be informed better on the risk of injuries to the dental elements such as fractures, luxations, or avulsions, especially to incisors. In the opinion of the authors, this new informed consent form allows the patient to know the risks related to the orthodontic/surgical therapy better, thus preserving the surgeons from the civil risk and penalties of omission.
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Gonçalves JR, Cassano DS, Wolford LM, Santos-Pinto A, Márquez IM. Postsurgical Stability of Counterclockwise Maxillomandibular Advancement Surgery: Affect of Articular Disc Repositioning. J Oral Maxillofac Surg 2008; 66:724-38. [DOI: 10.1016/j.joms.2007.11.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 09/06/2007] [Accepted: 11/07/2007] [Indexed: 11/16/2022]
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Frey DR, Hatch JP, Van Sickels JE, Dolce C, Rugh JD. Effects of surgical mandibular advancement and rotation on signs and symptoms of temporomandibular disorder: A 2-year follow-up study. Am J Orthod Dentofacial Orthop 2008; 133:490.e1-8. [DOI: 10.1016/j.ajodo.2007.10.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 10/10/2006] [Accepted: 10/10/2006] [Indexed: 11/30/2022]
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Wolford LM, Reiche-Fischel O, Mehra P. Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac Surg 2003; 61:655-60; discussion 661. [PMID: 12796870 DOI: 10.1053/joms.2003.50131] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Larry M Wolford
- Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, Dallas, TX, USA.
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Berger JL, Pangrazio-Kulbersh V, Bacchus SN, Kaczynski R. Stability of bilateral sagittal split ramus osteotomy: rigid fixation versus transosseous wiring. Am J Orthod Dentofacial Orthop 2000; 118:397-403. [PMID: 11029735 DOI: 10.1067/mod.2000.108781] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although many improvements have been made in orthodontic surgical procedures for mandibular retrognathism, relapse continues to occur. This study was designed to compare the stability of rigid and nonrigid fixation between 2 groups of patients who had undergone mandibular advancement surgery via sagittal split ramus osteotomy. Retrospective cephalometric measurements were made on 54 randomly selected orthognathic surgical patients. The patients, 7 males and 47 females, were divided into 2 groups: 28 patients stabilized by means of rigid fixation and 26 patients fixated with interosseous wires. The age of the patients ranged from 15.3 to 49.7 years. Lateral cephalograms were used to evaluate each patient at 3 distinct intervals: 7.0 +/- 2.0 days before surgery (T1), 34.4 +/- 15.0 days postsurgery (T2), and 458 +/- 202 days after sagittal split osteotomy (T3). Eighteen linear and angular measurements were recorded and differences between the 3 time periods were evaluated. Statistical analyses were performed to assess the differences in the 2 fixation types between and within each group at different time intervals. The following measurements showed statistically significant skeletal relapse over time, for the P value.0028: Co-Go, ANS-Xi-Pm, IMPA, overbite, and overjet. The remaining variables showed no statistically significant relapse. The only measurement that showed a statistically significant group difference between T1 and T2 was DC-Xi-Pm. Results of the study led to the following conclusions: there was statistically significant relapse in mandibular length, lower anterior face height, mandibular arc, lower incisor inclination, overbite, and overjet in each group, regardless of the type of fixation. The potential was greater for relapse in patients stabilized with transosseous wiring. Although multifactorial, relapse in overbite and overjet may be a combination of skeletal and dental changes. (Am J Orthod Dentofacial Orthop 2000;118:397-403).
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Affiliation(s)
- J L Berger
- University of Detroit Mercy, School of Dentistry, Department of Orthodontics, Detroit, MI, USA.
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Hwang SJ, Haers PE, Zimmermann A, Oechslin C, Seifert B, Sailer HF. Surgical risk factors for condylar resorption after orthognathic surgery. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:542-52. [PMID: 10807709 DOI: 10.1067/moe.2000.105239] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to look for surgical risk factors for condylar resorption after orthognathic surgery. STUDY DESIGN Seventeen patients of a group of 452 patients who had undergone orthognathic surgery consecutively and who were in accordance with the inclusion criteria of this study showed postoperative condylar resorption (group I). Preoperative cephalometric characteristics and surgically induced movements of this group were compared with a control group of 17 of 452 patients (group II) in whom postoperative condylar resorption and skeletal relapse did not develop, despite mandibular retrognathism (ANB angle >4 degrees) and high mandibular plane angle (>40 degrees). RESULTS The kind of osteosynthesis used was not significantly different between the 2 groups. The amount of surgical advancements and the vertical movements of the jaws were not significantly different between the 2 groups. However, the distal (P =.005) and proximal (P =.007) mandibular segments were rotated significantly further counterclockwise in group I. Surgically induced posterior condylar displacement occurred significantly more frequently (P =.007) in group I. CONCLUSIONS Counterclockwise rotation of the distal and proximal mandibular segments and surgically induced posterior condylar displacement seem to be important surgical risk factors for postoperative condylar resorption. Therefore, these movements seem to be contraindicated in patients who are at high risk.
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Affiliation(s)
- S J Hwang
- University Zurich and University Hospital Zurich, Switzerland
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Wolford LM, Cardenas L. Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes. Am J Orthod Dentofacial Orthop 1999; 116:667-77. [PMID: 10587602 DOI: 10.1016/s0889-5406(99)70203-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Idiopathic condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. This article presents the diagnostic criteria for idiopathic condylar resorption and a new treatment protocol for management of this pathologic condition. Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years. These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite. Imaging usually demonstrates small resorbing condyles and TMJ articular disk dislocations. A specific treatment protocol has been developed to treat this condition that includes: (1) removal of hyperplastic synovial and bilaminar tissue; (2) disk repositioning and ligament repair; and (3) indicated orthognathic surgery to correct the functional and esthetic facial deformity. Patients with this condition respond well to the treatment protocol presented herein with elimination of the disease process. Two cases are presented to demonstrate this treatment protocol and outcomes that can be achieved. Idiopathic condylar resorption is a progressive disease that can be eliminated with the appropriate treatment protocol.
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Affiliation(s)
- L M Wolford
- Oral and Maxillofacial Surgery at Baylor College of Dentistry-Texas A & M University System, Dallas, TX, USA
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