Prevalence of TMJ problems among orthognathic patients preoperative & postoperative

Introduction:

TMJ (Tempro mandibular joint) problems are one of most controversial subject in dentistry due to multifactorial effect on the TMJ ( ). Pain, Noise, clicking and limitation of opening is the majority of problems with TMJ () .as modality of treatment there are conservative treatment like physiotherapy, drugs, Injections, Orthodontics and occlusal adjustment () and there are Non-conservative treatment like Surgical procedures with or without orthodontics (). Still the controversy surrounding the treatment and the effect of Musculoskeletal harmony correction by Orthognathic surgery .some studies show improvement in TMJ symptom (), on the other hand some studies show No improvement and Stability () or even deterioration (). The prevalence of TMD in relation to Malocclusion show increase in Class II patients especially in Patients with mandibular retrognathism ,low angle case and deep bite().TMD treatment will be more favorable results in patient with retrognathic mandible more than prognathic one() .

This is a retrospective study done on 100 patients whom had Bimaxillary orthognatic surgery in Maxillofacial department in Paracelsus krankenhaus ruit hospital in Ruit, Ostfildren, South of Germany between October 2011-2014. Investigation and examination was done on TMJ sign and symptoms before operation and after one year.

Material and Methods

The study group consists of 100 consecutive patients ( M, F) aged over 18 years with dentofacial deformities undergoing Bimaxillary orthognathic surgery at the department of oral and Maxillofacial surgery at Paracelsus Krankenhaus Ruit (Germany) between October 2011 and October 2014.

All patients received Lefort 1 osteotomy (with or without segmentation) and bilateral sagittal split osteotomy with miniplates fixation without IMF.

The patients were examined both clinically and radiographically. The clinical consists of: 1-exraoral examination and includes the presence or absence of TMJ clicking, crepitus and pain

All of patients were assessed radiologically three times, before the surgery, one week after surgery and one year after surgery by taking right lateral cephalometric x-rays

MRI was taken for patients with TMJ problems before the surgery to assess any internal derangement or pathology within the joint.