Orthognathic Surgery as a Treatment for Temporomandibular Disorders

Area of Science:

• Oral and Maxillofacial Surgery
• Orthodontics
• Temporomandibular Joint Disorders

Background:

• Orthognathic surgery is increasingly considered for managing temporomandibular disorders (TMDs).
• Evidence from well-controlled clinical trials is limited, with many studies suffering from inadequate experimental designs and potential biases.
• Existing research shows mixed results regarding the efficacy of orthognathic surgery in alleviating TMD signs and symptoms.

Purpose of the Study:

• To evaluate the current evidence supporting orthognathic surgery as a primary treatment for TMDs.
• To assess the impact of different surgical approaches on TMD outcomes.
• To determine the predictability of TMD symptom resolution following orthognathic procedures.

Main Methods:

• Systematic review of controlled clinical trials and high-quality observational studies.
• Analysis of studies focusing on Class II and Class III malocclusions treated with orthognathic surgery.
• Assessment of reported TMD signs and symptoms pre- and post-operatively.

Main Results:

• Limited high-quality evidence supports orthognathic surgery as a primary TMD treatment.
• Some Class III and Class II patients experienced reduced TMD signs and symptoms after surgery.
• Counter-clockwise mandibular rotation in Class II correction was associated with increased TMD symptoms.
• Individual patient variability makes predicting surgical outcomes for TMDs challenging.

Conclusions:

• Orthognathic surgery is not recommended as a primary management strategy for TMDs due to insufficient evidence and unpredictable outcomes.
• The potential for increased TMD symptoms, particularly with certain surgical techniques, highlights the need for caution.
• Irreversible treatments like orthognathic surgery should be reserved for cases where conservative management has failed.