Craniomaxillofacial deformities/sleep disorders/cosmetic surgery
Does Temporomandibular Joint Pathology With or Without Surgical Management Affect the Stability of Counterclockwise Rotation of the Maxillomandibular Complex in Orthognathic Surgery? A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.joms.2016.10.034Get rights and content

Purpose

This study was designed to determine the stability of counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) in orthognathic surgery with or without surgical correction of coexisting temporomandibular joint (TMJ) pathology.

Materials and Methods

The authors implemented a systematic review and meta-analysis. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed. Inclusion criteria were studies that analyzed CCWR of the MMC in regard to skeletal stability after orthognathic surgery in patients with or without pre-existing TMJ pathology that was or was not surgically corrected concomitantly. The predictor variables were patients who underwent CCWR of the MMC in the following subgroups: 1) healthy TMJs (presumed healthy based on history, clinical evaluation, and radiographic analysis but without magnetic resonance imaging [MRI] confirmation), 2) no TMJ assessment, 3) untreated TMJ disc displacement (confirmed by MRI), 4) TMJ disc displacement (confirmed by MRI) repositioned using Mitek anchors, and 5) reconstruction with TMJ total joint prosthesis. Outcome variables were surgical relapse for angular and linear measurements. Postsurgical mean changes for the occlusal plane (OP) and linear measurements using a fixed-effects model with a 95% confidence interval were analyzed.

Results

A total of 345 patients enrolled in 12 studies were included in this study. There was significant OP relapse and horizontal relapse at the B point and menton for studies with untreated TMJ disc displacement and studies without TMJ assessment (P < .005). There was significant horizontal relapse at the A point for studies with healthy TMJs, without assessment of the TMJs, and with TMJ reconstruction with total joint prostheses (P < .005). There was no significant vertical relapse at the B and A points for all subgroup analyses (P < .005).

Conclusion

The result of the meta-analysis suggests that CCWR of the MMC is a stable procedure for patients with healthy TMJs, patients undergoing concomitant TMJ disc repositioning with Mitek anchors, and patients with TMJ patient-fitted total joint prostheses but unstable in the presence of untreated TMJ disc displacements and when TMJ status is not assessed.

Section snippets

Materials and Methods

To address the purpose of this study, the authors designed and conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews.10

Results of Search

Figure 1 presents the process of evaluating articles for inclusion in the review and meta-analysis. The search strategy yielded 1,132 articles from all databases and 3 additional articles were identified through a manual search. Of 1,135 articles, 400 were duplicates and removed, 450 articles were excluded after reading the titles and abstracts, and full-text articles of the remaining 285 studies were reviewed independently by the 2 authors (E.A.A. and L.M.W.) for eligibility, and 273 of these

Discussion

This study investigated whether TMJ pathology with or without surgical management affects the stability of CCWR of the MMC in orthognathic surgery. The results of this study suggest that stability of CCWR of the MMC depends on the presurgical status of the TMJs. The result of the meta-analysis infers that CCWR of the MMC is a stable procedure for patients with 1) healthy TMJs, 2) concomitant TMJ disc repositioning with Mitek anchors, and 3) TMJ reconstruction with patient-fitted total TMJ

References (32)

  • L.M. Wolford et al.

    Successful reconstruction of non-growing hemifacial microsomia patients with unilateral temporomandibular joint total joint prostheses and orthognathic surgery

    J Oral Maxillofac Surg

    (2012)
  • J.R. Gonçalves et al.

    Disc repositioning: Does it really work?

    Oral Maxillofac Surg Clin North Am

    (2015)
  • L.M. Wolford et al.

    Condylar resorption of the temporomandibular joint: How do we treat it?

    Oral Maxillofac Surg Clin North Am

    (2015)
  • L.M. Wolford et al.

    A classification system for conditions causing condylar hyperplasia

    J Oral Maxillofac Surg

    (2014)
  • L.M. Wolford et al.

    Efficacy of high condylectomy for management of condylar hyperplasia

    Am J Orthod Dentofacial Orthop

    (2002)
  • L.M. Wolford et al.

    Idiopathic condylar resorption: Diagnosis, treatment protocol, and outcomes

    Am J Orthod Dentofacial Orthop

    (1999)
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    Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

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