Temporomandibuläre Funktionsbefunde nach Dysgnathieoperationen im Vergleich zu einer bevölkerungsrepräsentativen Studie

Evaluation of temporomandibular joint function after orthognathic surgery using a jaw tracker

OBJECTIVE

It has been reported that temporomandibular joint (TMJ) function after orthognathic surgery differs from normal patients. Dysfunction of the joints occurs often even in the general public, with an incidence in the range of 20%-25%. Population-based studies among adults report that approximately 10%-15% have symptoms of pain and 5% of them had a perceived need for treatment. To date, no studies have reported on the evaluation of TMJ function after orthognathic surgery through the use of four-dimensional jaw tracking.

DESIGN AND SETTING

This study evaluated TMJ function using such a device and information from a TMJ questionnaire. Sixteen orthognathic surgery patients and 17 controls were included in this study. Four-dimensional jaw tracking information was obtained using the SiCAT JMT device. Clinical signs and jaw function were evaluated.

RESULTS

Within the limitations of the study, the following results were seen using the SICAT JMT+ jaw tracking device: (1) no significant differences were found in any of the millimetric measurements between the surgery patients and controls; (2) no significant difference was found in subjective reported symptoms of pain, clicking, crepitation, locking, stiffness, headaches and migraines between the groups; and (3)there was a significant difference in the popping of the joints for surgery and non-surgery groups.

CONCLUSION

Jaw tracking did not detect significant differences in jaw function, but some clinical symptoms were present.

3D analysis of condylar position after sagittal split osteotomy of the mandible in mono- and bimaxillary orthognathic surgery - a methodology study in 18 patients

OBJECTIVES

This study analyzes the condylar position with intercondylar distance and angle after sagittal split osteotomy in mono- and bimaxillary orthognathic surgery applying cone-beam computed tomography (CBCT) images before and after surgery.

MATERIALS AND METHODS

Data of 18 patients, ten males (mean age 28 years) and eight females (mean age 26 years) undergoing the described surgery between 2008 and 2009 were analyzed. CBCT scans were performed with the KaVo 3DeXam (KaVo, Biberach/ Riß, Germany) (identical with the iCAT scan device) before and after surgery. The exported DICOM data were analyzed with ImageJ morphometry software. Patients were also asked about TMJ problems. The two-tailed t test was used and significance was set at a p value less than p = 0.05.

RESULTS

There was no significant difference between the pre- and postoperative distances between condylar centers (mean difference: 1 mm) (p = 0.69) and intercondylar angle (mean difference: 6.6°) (p = 0.27).

CONCLUSIONS

CBCT is a novel imaging technique appropriate for detailed and three-dimensional analysis of the condylar position in orthognathic surgery. Available freeware analysis software can be applied for metrical measurements. Our cases showed no significant changes of condylar position immediately after surgery without intraoperative condylar fixation.

Factors of importance for the functional outcome in orthognathic surgery patients: a prospective study of 118 patients

PURPOSE

The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction.

PATIENTS AND METHODS

A total of 118 adult patients (51 men and 67 women) who were treated with orthognathic surgery were examined before and a minimum of 12 months after the surgical intervention. The stomatognathic function was evaluated with Helkimo's Anamnestic and Clinical Dysfunction index. The former was also used to assess a control group of 47 individuals with the same age and gender distribution and with no history of or present need for orthodontic treatment.

RESULTS

A total of 76 patients (64.4%) reported severe dysfunction at the beginning of the treatment, and 24 patients (20.3%) reported severe dysfunction at the end of the treatment. Clinical assessment showed that 36 patients (30.5%) had severe dysfunction symptoms upon inclusion versus only 5 (4.2%) at the final examination. However, 3 patients (2.5%) without clinical dysfunction at the time of inclusion developed mild dysfunction during treatment, and 8 patients (6.8%) developed increased dysfunction during treatment. The patients' functional status after treatment and their degree of satisfaction with the treatment were positively correlated. Although a general improvement was verified, the functional status of those who were treated never reached that of the control group.

CONCLUSION

This study indicates that orthognathic surgery improves patients' stomatognathic function in most cases, and that patients' satisfaction correlated with perceived, reported, and measured function at the end of the treatment.