Clinical Articles
Condylar and temporomandibular joint disc positions after mandibular osteotomy for prognathism

https://doi.org/10.1053/joms.2002.36098Get rights and content

Abstract

Purpose: The purpose of this study was to compare the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy. Patients and Methods: Of 43 patients with a diagnosed jaw deformity, 20 underwent IVRO without internal fixation and 23 underwent SSRO with rigid internal fixation. Some operations were performed in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including the disc position, were assessed preoperatively and postoperatively using magnetic resonance imaging (MRI) and axial cephalography. Results: A significant difference in the direction of condylar rotation was seen in horizontal axial cephalographia images (P <.01). Fewer or no TMJ symptoms were reported postoperatively by 88% of the patients who underwent IVRO with or without a Le Fort I osteotomy and by 66.7% of patients who underwent SSRO with or without a Le Fort I osteotomy. In sagittal images, no change was seen in anterior disc displacement after SSRO; however, improvement was seen in 44.4% of patients with anterior disc displacement who underwent IVRO with or without a Le Fort I osteotomy. Conclusion: These results suggest that SSRO does not improve anterior disc displacement; IVRO improves anterior disc displacement in the initial postsurgical period, and both procedures may improve TMJ symptoms. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1424-1432, 2002

Section snippets

Patients

The 43 Japanese patients in this study presented with jaw deformities diagnosed as mandibular prognathism (n = 22), mandibular prognathism with mandibular asymmetry (n = 7), and mandibular prognathism with bimaxillary asymmetry (n = 14). At the time of orthognathic surgery, the patients ranged in age from 15 to 37 years, with a mean age of 23.0 years.

Surgery

Of the 43 patients in this study, 23 underwent bilateral SSRO (by the Obwegeser Dal-Pont method) for correction of their mandibular deformities.

Condyle position

Postoperatively, the highest point of the condyle was more anteroinferior than it was preoperatively in 52.5% of the joints that underwent IVRO and in 23.9% of the joints that underwent SSRO. However, no statistically significant difference was found between the 2 procedures (Fig 3).

. Postoperative changes in condylar position seen in sagittal images. A, SSRO with or without LeFort I; B, IVRO with or without LeFort I.

Similarly, no significant difference in the angle of the condylar long axis was

Discussion

The functional rehabilitation of patients is one of the treatment goals of orthognathic surgery. Therefore, the purpose of orthognathic surgery is not only to produce ideal occlusion, but to also possibly reduce TMJ symptoms.

Signs and symptoms of TMJ dysfunction were previously studied in patients with dentofacial deformities. Laskin et al8 reported that 14% (range, 0% to 75%) of patients had TMJ symptoms before orthognathic surgery. Kerstens et al9 reported that 16.2% of 480 patients with

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Address correspondence and reprint requests to Dr Ueki: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan; e-mail: [email protected]

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