Evaluation of temporomandibular disorders before and after orthognathic surgery: Therapeutic considerations on a sample of 76 patients

Abstract

Objectives:Temporomandibular disorders may be associated with dental and facial malformations. The aim of this study is to record the prevalence of TMDs in patients scheduled for orthognathic surgery, reporting the development of TMDs and symptoms during the entire period of the treatment, and demonstrating the benefits of a team effort on this population.Materials and Methods:Assessment of temporomandibular status was performed using the RDC/TMD criteria at T0 (prior to orthodontic therapy), T1 (3 months after the surgery), and T2 post-therapeutic cycle (6 to 12 months postoperatively). A total of 76 participants were included in the study; all the patients underwent surgical treatment: 12 had bilateral sagittal split osteotomy, 6 with condylar position devices; 64 had Le Fort I + bilateral sagittal split osteotomy, and 15 with condylar position devices. Results were evaluated with a paired-sample t-test and segmentation analysis.Results:Forty-seven patients were affected by TMDs. At T0, 25 patients experienced TMJ pain, 27 had muscular pain, 31 suffered headaches, 42 had disc dislocation with reduction, and 5 were affected by disc dislocation without reduction. Thirty-five patients had occlusal signs of parafunctions, 8 reported tinnitus, and 7 dizziness. At T1, TMJ pain changed from 33.3% to 4.44%, muscular pain changed from 35.5% to 11.1%, headaches improved from 40% to 6.67%, and disc dislocation from 55.2% to 17.7%. Segmentation analysis highlighted improvement after therapy; 57 patients were considered recovered, 14 improved, none were considered stable, whereas 5 patients demonstrated some worsening, 3 of whom had not presented disc dislocation before surgery. At T2, 71 patients were considered completely recovered or improved.Conclusions:Our data indicates beyond any doubt that both functional status and pain levels related to TMDs can be significantly improved with a multi-disciplinary approach. We concluded that surgeon's intervention need to be modified in the presence of presurgical TMDs.

Prevalence of Temporomandibular Disorders in Orthognathic Surgery patients: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions

“…15,16 Orthognathic surgery is a surgical procedure performed to correct jaw and facial deformities caused by abnormalities in the structure or position of the jaws. [17][18][19][20] These procedures are typically performed under general anaesthesia in a hospital setting, with the use of specialised instruments to make precise cuts in the jawbone. 21 They are typically used to correct functional problems, such as difficulty with chewing or speech, as well as aesthetic concerns related to facial symmetry and balance.…”

“…Orthognathic surgery is a surgical procedure performed to correct jaw and facial deformities caused by abnormalities in the structure or position of the jaws 17–20 . These procedures are typically performed under general anaesthesia in a hospital setting, with the use of specialised instruments to make precise cuts in the jawbone 21 .…”