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

Abstract

ObjectiveIn order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. MethodsA literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. ResultsA total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. ConclusionsYoung adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery.

ENPP1 and ESR1 genotypes influence temporomandibular disorders development and surgical treatment response in dentofacial deformities

“…Although the link between TMD and orthognathic surgery is a subject of increased interest in the literature, a small number of quality studies have examined the predictors of symptomatic articular response to this surgical treatment (Dicker et al, 2015; Pusan Korea Pusan National University et al, 2015; Scolozzi et al, 2015; Valladares-Neto et al, 2014). …”

“…From a demographic point of view, young age and female sex are factors influencing post-surgical joint symptoms (Valladares-Neto et al, 2014). Valladares-Neto et al (Valladares-Neto et al, 2014) have also shown the importance of mandibular advancement, the degree of counterclockwise rotation of the mandible and the rigidity of fixation technique could be factors influencing the TMJ health. Thus, young adult females with mandibular retrognathism and increased mandibular plane angle would present a smaller joint improvement after orthognathic surgery and would be more prone to postoperative condylar resorption.…”

“…Abrahamsson et al (Abrahamsson et al, 2013) have shown in a controlled study on patients with dentofacial deformities, a positive impact on TMJ health from combined orthodontic and surgical treatment, particularly for the relief of pain. Angle Class I occlusion thus seems beneficial to temporomandibular biomechanics, but few studies have highlighted the predictors of response to surgical treatment (Pusan Korea Pusan National University et al, 2015; Scolozzi et al, 2015; Valladares-Neto et al, 2014). Female sex, amount of mandibular advancement and degree counterclockwise rotation of the mandible appear to be the main factors influencing the TMJ health after bilateral sagittal split osteotomy (Valladares-Neto et al, 2014).…”

“…Angle Class I occlusion thus seems beneficial to temporomandibular biomechanics, but few studies have highlighted the predictors of response to surgical treatment (Pusan Korea Pusan National University et al, 2015; Scolozzi et al, 2015; Valladares-Neto et al, 2014). Female sex, amount of mandibular advancement and degree counterclockwise rotation of the mandible appear to be the main factors influencing the TMJ health after bilateral sagittal split osteotomy (Valladares-Neto et al, 2014). Women with class II malocclusion and increased vertical dimension as indicated by a larger mandibular plane angle, in fact have less TMJ improvements and are more prone to postoperative condylar resorption.…”

Counterclockwise maxillomandibular advancement surgery and disc repositioning: can condylar remodeling in the long-term follow-up be predicted?

“…Previous studies have shown that a high mandibular plane angle, mandibular retrognathism, and female sex are some of the risk factors for condylar resorption, particularly following mandibular advancement surgery 14,27,30–32 . However, Hoppenreijs et al 16 reported that the mandibular plane angle might be less important than has been assumed in the literature 24,30 .…”