Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study
Tóm tắt
Relations between maxillo-mandibular deformities and TMJ disorders have been the object of different studies in medical literature and there are various opinions concerning the alteration of TMJ dysfunction after orthognathic surgery. The purpose of the present study was to evaluate TMJ disorders changes before and after orthognathic surgery, and to assess the risk of creating new TMJ symptoms on asymptomatic patients.
A questionnaire was sent to 176 patients operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri) from 01.01.2006 to 01.01.2008. 57 patients (35 females and 22 males), age range from 16 to 65 years old, filled the questionnaire. The prevalence and the results on pain, sounds, clicking, joint locking, limited mouth opening, and tenseness were evaluated comparing different subgroups of patients.
TMJ symptoms were significantly reduced after treatment for patients with pre-operative symptoms. The overall subjective treatment outcome was: improvement for 80.0% of patients, no change for 16.4% of patients, and an increase of symptoms for 3.6% of them. Thus, most patients were very satisfied with the results. However the appearance of new onset of TMJ symptoms is common. There was no statistical difference in the prevalence of preoperative TMJ symptoms and on postoperative results in class II compared to class III patients.
These observations demonstrate that: there is a high prevalence of TMJ disorders in dysgnathic patients; most of patients with preoperative TMJ signs and symptoms can improve TMJ dysfunction and pain levels can be reduced by orthognathic treatment; a percentage of dysgnathic patients who were preoperatively asymptomatic can develop TMJ disorders after surgery but this risk is low.
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Tài liệu tham khảo
Karabouta I, Martis C: The TMJ dysfunction syndrome before and after sagittal split osteotomy of the rami. J Maxillofac Surg. 1985, 13: 185-188. 10.1016/S0301-0503(85)80045-X.
Magnusson T, Ahlborg G, Svartz K: Function of the masticatory system in 20 patients with mandibular hypo- or hyperplasia after correction by a sagittal split osteotomy. Int J Oral Maxillofac Surg. 1990, 19: 289-293. 10.1016/S0901-5027(05)80423-0.
Onizawa K, Schmelzeisen R, Vogt S: Alteration of temporomandibular joint symptoms after orthognathic surgery: comparison with healthy volunteers. J Oral Maxillofac Surg. 1995, 53: 117-121. 10.1016/0278-2391(95)90383-6. discussion 121-123
Wolford LM, Reiche-Fischel O, Mehra P: Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac Surg. 2003, 61: 655-660. 10.1053/joms.2003.50131. discussion 661
Narayanan V, Guhan S, Sreekumar K, Ramadorai A: Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery: a retrospective study. Indian J Dent Res. 2008, 19: 12-16. 10.4103/0970-9290.38925.
Pahkala RH, Kellokoski JK: Surgical-orthodontic treatment and patients' functional and psychosocial well-being. Am J Orthod Dentofacial Orthop. 2007, 132: 158-164. 10.1016/j.ajodo.2005.09.033.
Kerstens HC, Tuinzing DB, Golding RP, Van der Kwast WA: Inclination of the temporomandibular joint eminence and anterior disc displacement. Int J Oral Maxillofac Surg. 1989, 18: 228-232. 10.1016/S0901-5027(89)80059-1.
O'Ryan F, Epker BN: Surgical orthodontics and the temporomandibular joint. II. Mandibular advancement via modified sagittal split ramus osteotomies. Am J Orthod. 1983, 83: 418-427. 10.1016/0002-9416(83)90325-1.
White CS, Dolwick MF: Prevalence and variance of temporomandibular dysfunction in orthognathic surgery patients. Int J Adult Orthodon Orthognath Surg. 1992, 7: 7-14.
De Clercq CA, Abeloos JS, Mommaerts MY, Neyt LF: Temporomandibular joint symptoms in an orthognathic surgery population. J Craniomaxillofac Surg. 1995, 23: 195-199.
Panula K, Somppi M, Finne K, Oikarinen K: Effects of orthognathic surgery on temporomandibular joint dysfunction. A controlled prospective 4-year follow-up study. Int J Oral Maxillofac Surg. 2000, 29: 183-187. 10.1016/S0901-5027(00)80089-2.
Kerstens HC, Tuinzing DB, van der Kwast WA: Temporomandibular joint symptoms in orthognathic surgery. J Craniomaxillofac Surg. 1989, 17: 215-218.
Finlay PM, Atkinson JM, Moos KF: Orthognathic surgery: patient expectations; psychological profile and satisfaction with outcome. Br J Oral Maxillofac Surg. 1995, 33: 9-14. 10.1016/0266-4356(95)90078-0.
Storum KA, Bell WH: Hypomobility after maxillary and mandibular osteotomies. Oral Surg Oral Med Oral Pathol. 1984, 57: 7-12. 10.1016/0030-4220(84)90249-4.
Cascone P, Di Paolo C, Leonardi R, Pedullà E: Temporomandibular disorders and orthognathic surgery. J Craniofac Surg. 2008, 19: 687-692. 10.1097/SCS.0b013e3180c31962.
Wolford LM, Karras S, Mehra P: Concomitant temporomandibular joint and orthognathic surgery: a preliminary report. J Oral Maxillofac Surg. 2002, 60: 356-62. 10.1053/joms.2002.31220. discussion 362-363
Buckley MJ, Tulloch JF, White RP, Tucker MR: Complications of orthognathic surgery: a comparison between wire fixation and rigid internal fixation. Int J Adult Orthodon Orthognath Surg. 1989, 4: 69-74.
Nemeth DZ, Rodrigues-Garcia RC, Sakai S, Hatch JP, Van Sickels JE, Bays RA, Clark GM, Rugh JD: Bilateral sagittal split osteotomy and temporomandibular disorder. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000, 89: 29-34. 10.1016/S1079-2104(00)80010-4.
De Clercq CA, Neyt LF, Mommaerts MY, Abeloos JV, De Mot BM: Condylar resorption in orthognathic surgery: a retrospective study. Int J Adult Orthodon Orthognath Surg. 1994, 9: 233-240.
Crawford JG, Stoelinga PJ, Blijdorp PA, Brouns JJ: Stability after reoperation for progressive condylar resorption after orthognathic surgery: report of seven cases. J Oral Maxillofac Surg. 1994, 52: 460-466. 10.1016/0278-2391(94)90341-7.
Nitzan DW, Dolwick MF: Temporomandibular joint fibrous ankylosis following orthognathic surgery: report of eight cases. Int J Adult Orthodon Orthognath Surg. 1989, 4: 7-11.
Westermark A, Shayeghi F, Thor A: Temporomandibular dysfunction in 1,516 patients before and after orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 2001, 16: 145-151.
Sostmann M, Meyer J, Berten JL: TMJ function following orthognathic surgery. Dtsch Stomatol. 1991, 41: 487-489.
Flanary CM, Barnwell GM, Alexander JM: Patient perceptions of orthognathic surgery. Am J Orthod. 1985, 88: 137-145. 10.1016/0002-9416(85)90238-6.
Pahkala R, Heino J: Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy-two patients. Acta Odontol Scand. 2004, 62: 238-244. 10.1080/00016350410001667.