J Korean Assoc Oral Maxillofac Surg.  2012 Jun;38(3):139-144. 10.5125/jkaoms.2012.38.3.139.

Clinical evaluation of temporomandibular joint disorder after orthognathic surgery in skeletal class II malocclusion patients

• Jang JH
• Choi SK
• Park SH
• Kim JW
• Kim SJ
• Kim MR

• KMID: 2043842
• DOI: http://doi.org/10.5125/jkaoms.2012.38.3.139

Abstract

OBJECTIVES
This study was performed in order to evaluate the occurrence of temporomandibular joint disorder after surgical correction of skeletal class II malocclusion.
MATERIALS AND METHODS
This study included 21 patients who underwent orthognathic surgery for the correction of dentofacial deformities by a single surgeon at Mokdong Hospital, Ewha Womans University from 2000 to 2010. They underwent bilateral sagittal split ramus osteotomy for the treatment of undesirable mandibular advancement. The temporomandibular disorder (TMD) symptoms prior to surgery were recorded and the radiographic evaluation (panorama, bone scan, and magnetic resonance imaging [MRI]) of the post-surgery temporomandibular joint (TMJ) were assessed in order to evaluate condylar resorption, remodeling and disc displacement. The minimum follow-up period, including orthodontic treatment, was 12 months. Orthognathic procedures included 1-jaw surgery (n=8 patients) and 2-jaw surgery (n=13 patients). The monocortical plate was used for bilateral sagittal split ramus osteotomy fixation.
RESULTS
Among class II malocclusion patients with TMD symptom, clicking improved in 29.1%, and maximum mouth opening increased from 34.5+/-2.1 mm to 37.2+/-3.5 mm. The differences were not statistically significant, however. Radiographic changes in bone scan improved slightly based on the report by radiologist but not in TMJ dynamic MRI.
CONCLUSION
No particular improvements were found in patients with joint sound only. Patients with limitation of mouth opening showed an increase in the degree of opening, but the difference was not statistically significant (P>0.05).

Keyword

Orthognathic surgery; Class II malocclusion; Temporomandibular joint disorders; Clinical evaluation

MeSH Terms

Dentofacial Deformities
Displacement (Psychology)
Female
Follow-Up Studies
Humans
Joints
Magnetic Resonance Imaging
Malocclusion
Mandibular Advancement
Mouth
Orthognathic Surgery
Osteotomy, Sagittal Split Ramus
Temporomandibular Joint
Temporomandibular Joint Disorders

Figure

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  Fig. 1. Changes in TMJ noise after orthognathic surgery in group 1. (TMJ: temporomandibular joint, PreOp: preoperative, PostOp: postoperative)

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  Fig. 2. Changes after operation in limitation of mouth opening only (group 2). (PreOp: preoperative, PostOp: postoperative)

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  Fig. 3. Changes after the operation in group 3 patient (group 3). (TMJ: temporomandibular joint, PreOp: preoperative, PostOp: postoperative)

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  Fig. 4. Changes of mouth opening after the operation in limited mouth opening with TMJ pain (group 4). (TMJ: temporomandibular joint, PreOp: preoperative, PostOp: postoperative)

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  Fig. 5. Changes of bone scan after orthognathic surgery (right: 2 years before, left: 1 year after orthognathic surgery).

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  Fig. 6. Changes of magnetic resonance imaging after orthognathic surgery. 2 years, 1 month, and 1 year after orthognathic surgery. Anterior disc displacement has not changed (patient 1, 2-jaw). (LT: left)

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  Fig. 7. Changes of magnetic resonance imaging after orthognathic surgery. 2 years before, and 1 year after orthognathic surgery. Anterior disc displacement has not changed (patient 2). (LT: left)

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