Clinical evaluation of temporomandibular joint disorder after orthognathic surgery in skeletal class II malocclusion patients

Jin-Hyun Jang; Sung-Keun Choi; Sung-Ho Park; Jin-Woo Kim; Sun-Jong Kim; Myung-Rae Kim

doi:10.5125/jkaoms.2012.38.3.139

Original Article

J Korean Assoc Oral Maxillofac Surg 2012;38(3):139-144.

Published online: 26 June 2012

DOI: https://doi.org/10.5125/jkaoms.2012.38.3.139

Clinical evaluation of temporomandibular joint disorder after orthognathic surgery in skeletal class II malocclusion patients

Jin-Hyun Jang, Sung-Keun Choi, Sung-Ho Park, Jin-Woo Kim, Sun-Jong Kim, Myung-Rae Kim

Department of Oral and Maxillofacial Surgery, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea

Sun-Jong Kim Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea TEL: +82-2-2650-5041 FAX: +82-2-2650-5764 E-mail: sjsj7777@ewha.ac.kr

Received 5 March 2012 Revised 17 May 2012 Accepted 18 May 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

This study was performed in order to evaluate the occurrence of temporomandibular joint disorder after surgical correction of skeletal class II malocclusion.

Materials and Methods

This study included 21 patients who underwent orthognathic surgery for the correction of dentofacial deformities by a single surgeon at Mokdong Hospital, Ewha Womans University from 2000 to 2010. They underwent bilateral sagittal split ramus osteotomy for the treatment of undesirable mandibular advancement. The temporomandibular disorder (TMD) symptoms prior to surgery were recorded and the radiographic evaluation (panorama, bone scan, and magnetic resonance imaging [MRI]) of the post-surgery temporomandibular joint (TMJ) were assessed in order to evaluate condylar resorption, remodeling and disc displacement. The minimum follow-up period, including orthodontic treatment, was 12 months. Orthognathic procedures included 1-jaw surgery (n=8 patients) and 2-jaw surgery (n=13 patients). The monocortical plate was used for bilateral sagittal split ramus osteotomy fixation.

Results

Among class II malocclusion patients with TMD symptom, clicking improved in 29.1%, and maximum mouth opening increased from 34.5±2.1 mm to 37.2±3.5 mm. The differences were not statistically significant, however. Radiographic changes in bone scan improved slightly based on the report by radiologist but not in TMJ dynamic MRI.

Conclusion

No particular improvements were found in patients with joint sound only. Patients with limitation of mouth opening showed an increase in the degree of opening, but the difference was not statistically significant (P>0.05).

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Keywords: Orthognathic surgery, Class II malocclusion, Temporomandibular joint disorders, Clinical evaluation

Fig. 1.

Changes in TMJ noise after orthognathic surgery in group 1. (TMJ: temporomandibular joint, PreOp: preoperative, PostOp: postoperative)

Fig. 2.

Changes after operation in limitation of mouth opening only (group 2). (PreOp: preoperative, PostOp: postoperative)

Fig. 3.

Changes after the operation in group 3 patient (group 3). (TMJ: temporomandibular joint, PreOp: preoperative, PostOp: postoperative)

Fig. 4.

Changes of mouth opening after the operation in limited mouth opening with TMJ pain (group 4). (TMJ: temporomandibular joint, PreOp: preoperative, PostOp: postoperative)

Fig. 5.

Changes of bone scan after orthognathic surgery (right: 2 years before, left: 1 year after orthognathic surgery).

Fig. 6.

Changes of magnetic resonance imaging after orthognathic surgery. 2 years, 1 month, and 1 year after orthognathic surgery. Anterior disc displacement has not changed (patient 1, 2-jaw). (LT: left)

Fig. 7.

Changes of magnetic resonance imaging after orthognathic surgery. 2 years before, and 1 year after orthognathic surgery. Anterior disc displacement has not changed (patient 2). (LT: left)

Table 1.

Classification of patients G4 PreOp and PostOp MMO

Patient	No. of patients	TMJ noise	LOM (<35 mm)	TMJ pain
G1	n=7	+	-	-
G2	n=4	-	+	-
G3	n=5	+	-	+
G4	n=5	-	+	+

(PreOp: preoperative, PostOp: postoperative, MMO: maximum mouth opening, TMJ: temporomandibular joint, LOM: limitation of mouth opening, G1: group 1, G2: group 2, G3: group 3, G4: group 4)

Table 2.

PreOp and PostOp MMO of G4

Patient	PreOp	PostOp 6 months
Patient 1	32.00	35.00
Patient 2	33.00	36.00
Patient 3	34.00	40.00
Patient 4	35.00	46.00
Patient 5	32.00	45.00

(PreOp: preoperative, PostOp: postoperative, MMO: maximum mouth opening, G4: group 4)

Table 3.

Paired t-test of group 4

Paired samples test¹
		Paired differences					T	df	Sig. (2-tailed)
		Mean	Std. deviation	Std. error mean	95% confidence interval of the difference
		Mean	Std. deviation	Std. error mean	Lower	Upper
Pair 1	PreOp–PostOp 6 months	-7.20000	4.60435	2.05913	-12.91705	-1.48295	-3.497	4	0.025

(Std.: standard, df: degree of freedom, Sig.: significant)

¹ No statistics are computed for one or more split files.

Table 4.

Changes after the operation in bone scan findings

Patient	PreOp TMJ bone scan findings	PostOp (minimum 6 month after) TMJ bone scan findings
Patient 1	Suggestive arthritis	Mild uptake
Patient 2	Mild uptake	No activity on TMJ
Patient 3	Increased uptake	Mild uptake
Patient 4	Mild uptake	Increased uptake
Patient 5	Mild uptake	Mild uptake

(PreOp: preoperative, PostOp: postoperative, TMJ: temporomandibular joint)

Table 5.

MRI changes in 2 patients

	PreOp MRI	PostOp MRI (minimum 6 month after)
Patient 1	ADD without reduction	ADD without reduction, no change from PreOp MRI finding
Patient 2	ADD without reduction	ADD without reduction, no change from PreOp MRI finding

(PreOp: preoperative, PostOp: postoperative, MRI: magnetic resonance imaging, ADD: anterior disc displacement)

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