Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

Perception of improvement after orthognathic surgery: the important variables affecting patient satisfaction

PURPOSE: We evaluated which factors affect patient satisfaction and if patient expectations were fulfilled after orthognathic surgery. METHODS: Questionnaires consisting of 14 questions were given 1 year after bimaxillary osteotomy for class-III correction to subjects. Six questions were answered using an 11-point rating scale based on a visual analog scale (VAS; 0 = poor; 10 = excellent). Also included were seven closed-form questions with yes/no answers, as well as one open question for 'further remarks'. Sagittal and vertical cephalometric parameters were determined on postoperative cephalograms. RESULTS: Seventy-seven patients (37 females, 40 males; mean age, 23.4 +/- 4.9 (SD) years) responded. The intention to undergo surgery only for aesthetic improvement was noted in 11.9% of patients; only improvement of chewing function in 15.5%; both in 71.4%; and none/don't know in 2.6%. Postoperative satisfaction was rated (in means) with 8.13 +/- 1.97 on VAS and correlated significantly with the opinions of friends and relatives. Facial aesthetics was rated 5.6 +/- 1.2 before surgery and 8.1 +/- 1.5 after surgery (p = 0.04). Preoperative chewing function was rated 5.65 +/- 1.8 and 8.03 +/- 1.51 after surgery (p = 0.014). TMJ disorders or hypoesthesia had no negative impacts. Cephalometric analyses revealed a significantly lower SNB (75.3 degrees +/- 2.7 degrees ; p = 0.033) in patients rating lower than grade 7 for overall satisfaction. For SNA and ArGoMe, no significant differences were observed. CONCLUSION: The most distinctive factors for patient satisfaction after orthognathic surgery were chewing function and facial aesthetics with respect to the lower face. Function, aesthetics, and even psychological aspects should be considered equally when planning surgery

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

Objective: In 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. Methods: A 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. Results: A 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. Conclusions: Young 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

Speech evaluation in children with temporomandibular disorders

OBJECTIVE: The aims of this study were to evaluate the influence of temporomandibular disorders (TMD) on speech in children, and to verify the influence of occlusal characteristics. MATERIAL AND METHODS: Speech and dental occlusal characteristics were assessed in 152 Brazilian children (78 boys and 74 girls), aged 8 to 12 (mean age 10.05 ± 1.39 years) with or without TMD signs and symptoms. The clinical signs were evaluated using the Research Diagnostic Criteria for TMD (RDC/TMD) (axis I) and the symptoms were evaluated using a questionnaire. The following groups were formed: Group TMD (n=40), TMD signs and symptoms (Group S and S, n=68), TMD signs or symptoms (Group S or S, n=33), and without signs and symptoms (Group N, n=11). Articulatory speech disorders were diagnosed during spontaneous speech and repetition of the words using the "Phonological Assessment of Child Speech" for the Portuguese language. It was also applied a list of 40 phonological balanced words, read by the speech pathologist and repeated by the children. Data were analyzed by descriptive statistics, Fisher's exact or Chi-square tests (&#945;=0.05). RESULTS: A slight prevalence of articulatory disturbances, such as substitutions, omissions and distortions of the sibilants /s/ and /z/, and no deviations in jaw lateral movements were observed. Reduction of vertical amplitude was found in 10 children, the prevalence being greater in TMD signs and symptoms children than in the normal children. The tongue protrusion in phonemes /t/, /d/, /n/, /l/ and frontal lips in phonemes /s/ and /z/ were the most prevalent visual alterations. There was a high percentage of dental occlusal alterations. CONCLUSIONS: There was no association between TMD and speech disorders. Occlusal alterations may be factors of influence, allowing distortions and frontal lisp in phonemes /s/ and /z/ and inadequate tongue position in phonemes /t/; /d/; /n/; /l/

Signs and symptoms of temporomandibular disorders in adolescents Sinais e sintomas de disfunção temporomandibular em adolescentes

The aim of this study was to verify the prevalence of signs and symptoms of temporomandibular disorders (TMD) in adolescents and its relationship to gender. The sample comprised 217 subjects, aged 12 to 18. The subjective symptoms and clinical signs of TMD were evaluated, using, respectively, a self-report questionnaire and the Craniomandibular Index, which has 2 subscales; the Dysfunction Index and the Palpation Index. The results of muscle tenderness showed great variability (0.9-32.25%). In relation to the temporomandibular joint, tenderness of the superior, dorsal and lateral condyle regions occurred in 10.6%, 10.6% and 7.83%, respectively, of the sample. Joint sound during opening was present in 19.8% of the sample and during closing in 14.7%. The most prevalent symptoms were joint sounds (26.72%) and headache (21.65%). There was no statistical difference between genders (p > 0.05), except for the tenderness of the lateral pterygoid muscles, which presented more prevalence in girls. In conclusion, clinical signs and symptoms of TMD can occur in adolescents; however, gender influence was not perceived.<br>O objetivo deste estudo foi verificar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM) em adolescentes e sua relação com o gênero. A amostra foi constituída de 217 voluntários, com idade entre 12 e 18 anos. Os sintomas subjetivos e os sinais clínicos de DTM foram avaliados usando-se, respectivamente, um questionário e o "Craniomandibular Index", o qual possui 2 subescalas: "Dysfunction Index" e "Palpation Index". Os resultados para sensibilidade muscular mostraram grande variabilidade (0,9-32,25%). Com relação à articulação temporomandibular, a sensibilidade à palpação nas regiões superior, dorsal e lateral do côndilo ocorreu, respectivamente, em 10,6%, 10,6% e 7,83% da amostra. A prevalência do ruído articular no movimento de abertura foi de 19,8% e no fechamento, 14,7%. Os sintomas relatados mais prevalentes foram o ruído articular (26,72%) e dor de cabeça (21,65%). Nenhuma diferença estatística foi encontrada para a associação entre os gêneros (p > 0,05), exceto para a sensibilidade no músculo pterigóideo lateral, a qual se apresentou mais prevalente nas meninas. Os sinais clínicos e sintomas subjetivos de DTM foram observados em adolescentes, no entanto a influência do gênero não foi percebida nessa faixa etária

Assessment of occlusion with the T-Scan system in patients undergoing orthognathic surgery

Dental occlusion varies among individuals, and achieving correct physiological occlusion after osteotomy is essential for the complex functioning of the stomatognathic system. The T-Scan system records the centre of force, first contact, maximum bite force, and maximum intercuspation. The aim of the present study was to investigate the usefulness and consistency of T-Scan in assessing occlusion before and after orthognathic surgery. Occlusal information was evaluated for 30 healthy adults with normal occlusion and 40 patients undergoing orthognathic surgery. T-Scan had a high degree of reliability for consecutive measurements (Pearson correlation, r = 0.98). For most parameters, occlusal distribution was better after surgery than before surgery. More teeth contributed to occlusion at maximum intercuspation after surgery than before surgery (14 vs. 10). In addition, the difference in the posterior force distribution was reduced after surgery (17.6 +/- 13.8 vs. 22.7 +/- 21.4 before surgery), indicating better occlusal force distribution after surgery. The maximum percentage force on teeth (p = 0.004) and the number of teeth contributing to occlusion (p < 0.001) also differed significantly. Thus, T-Scan is good for assessing occlusal discrepancies and can be used to portray the pre- and postoperative occlusal contact distribution during treatment planning and follow-up