Effect of “Surgery-first” orthognathic approach on temporomandibular symptoms and function: a comparison with “Orthodontic-first” approach

Publication date: Available online 24 October 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Kensuke Yamauchi, Tetsu Takahashi, Yoshihiro Yamaguchi, Hikari Suzuki, Shinnosuke Nogami, Junji Sugawara

Abstract

Objective

The aim of this study was to comparatively evaluate the effects of the Surgery-first approach (SFA) and Orthodontics-first approach (OFA) on temporomandibular joint (TMJ) function and maximum mouth opening.

Study Design

This retrospective study investigated the outcomes of patients with diagnosed skeletal class III dentofacial deformities. 24 patients were enrolled in the OFA group and 23 patients were enrolled in the SFA group. All patients were examined in the same manner four times: before surgery and at 1, 3, 6 and 12 months after surgery. Range of motion (ROM) was measured between the maxillary and mandibular central incisors. Symptoms were evaluated subjectively using a questionnaire with items pertaining to pain on mandibular movements, TMJ sounds, pain in masticatory muscles region.

Results

No severe complications or relapse occurred in either group during the 12-month follow-up period. Postoperative changes in ROM showed similar tendencies, but there was no significant difference in ROM during the follow-up period between OFA and SFA group (p< .05). The percentage reduction was nearly 45% at 1 month postoperatively and 20% at 3 months postoperatively compared with the preoperative situation. After 6 months postoperatively, the ROM was almost the same as before surgery. The number of patients with such sounds increased with time until 12- month postoperative examinations in the OFA group, but increased slightly during this period in the SFA group. During the first 3 months postoperatively, less than 10 % of patients in both groups had newly detected pain of TMJ and/or muscles. At 6 and 12 months postoperatively, only one patient in the SFA group have pain.

Conclusion

No significant differences in TMJ symptoms or function were observed during a 12-month follow-up period between patients with skeletal class III malocclusion treated with the SFA and those treated with the OFA.

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