Histologic and tomographic analyses of the temporomandibular joint after mandibular advancement surgery: study in minipigs

TMJ response to mandibular advancement surgery: an overview of risk factors

“…However, the major concern when the mandible is being surgically advanced and rigidly fixed is the risk of damaging the neurovascular bundle and imprecise condylar positioning due to the torque of the rami. In this respect, animal studies 45,99 have detected a more pronounced effect of the condyle when the rigidity of the fixation method was greater. The intense rigidity brought about by bicortical lag-screws may close the gap between the bone segments and torque the condyle, move it out of the mandibular fossa and cause transverse displacements of the proximal segments 14,15,42,140 .…”

“…They also obviate the need for transcutaneous puncture, and its subsequent scarring, reduce time spent in surgery, and pose less risk of nerve damage and condylar torque 15 . Because the system is less rigid 106,117 , it is also called semi-rigid fixation 99,109 . Several hybrid techniques have been cited, such as the miniplate with monocortical screw fixation and positional screws placed bicortically, by means of the plate, or placed separately above or below the plate 98,103,107,111 .…”

“…In vivo animal studies investigated the response of the TMJ to mandibular surgical advancement 45,87,99 . There was a more pronounced effect on the condyle (retrusion, erosion, flattening and osteophyte) when positional screws were used than when mini plates were used, suggesting that this was developed by the higher impact of the screws transmitted to the condyle.…”

“…The adverse effects of mandibular advancement surgery on the TMJs form a pertinent theme well explored in the literature 5,7,20,29,56,65,81,99,104,105,134,138,139,142 . The TMJ response ranged from adaptive, which included physiological bone remodeling 28,34,45 , to irreversible complications 9,10,55 .…”