Our Summary
This article looked at recent research about the link between orthognathic surgery (surgery to correct conditions affecting the jaw and face) and temporomandibular disorders (TMD, problems with the jaw joint and muscles). After reviewing 31 studies published over the last decade, the authors found that the impact of such surgery on TMD is unpredictable, meaning it is not a reliable treatment for joint problems.
The paper also discussed new findings. For example, teeth grinding, problems with oral function, and psychological factors could affect the outcomes of surgery. It also considered the issue of how the jaw joint (condyle) is positioned after surgery and the development of techniques to model the stresses placed on the joint.
In terms of who is more likely to have joint complications after surgery, the risk factors are not well understood. However, often cited are being female, having a certain facial skeletal class, a hyperdivergent profile, and using a rigid method to fix the bones in place. The most significant risk factor seems to be already having a joint dysfunction, especially a displaced disc in the jaw joint. This suggests that a thorough evaluation of the joint, including an MRI scan, should be done before surgery.
FAQs
- Is orthognathic surgery a reliable treatment for temporomandibular disorders (TMD)?
- What factors could affect the outcomes of orthognathic surgery?
- Who is more likely to have joint complications after orthognathic surgery and what precautions should be taken before the surgery?
Doctor’s Tip
A helpful tip a doctor might give a patient about orthognathic surgery is to undergo a thorough evaluation of the jaw joint, including an MRI scan, before the surgery to assess any pre-existing joint dysfunction. It is also important to discuss any teeth grinding, oral function issues, or psychological factors that could impact the outcome of the surgery. Additionally, understanding the potential risk factors for joint complications after surgery, such as being female, having a specific facial skeletal class, or using a rigid fixation method, can help in preparing for the procedure and managing post-operative care.
Suitable For
Patients who are typically recommended for orthognathic surgery include those with severe malocclusion (misalignment of the teeth and jaws), facial asymmetry, difficulty chewing or speaking, obstructive sleep apnea, and facial trauma resulting in jaw deformities. In some cases, orthodontic treatment alone may not be able to correct these issues, and surgery may be necessary to achieve optimal results. It is important for patients to undergo a comprehensive evaluation by a team of oral and maxillofacial surgeons, orthodontists, and other specialists to determine if they are good candidates for orthognathic surgery.
Timeline
Before orthognathic surgery, a patient typically undergoes consultations with a maxillofacial surgeon, orthodontist, and other specialists to determine if surgery is necessary. This process includes a comprehensive evaluation of the patient’s facial structure, bite alignment, and any existing jaw joint issues. Pre-surgical orthodontic treatment is often required to align the teeth and ensure a stable bite for post-surgery results.
During the surgery itself, the maxillofacial surgeon makes precise cuts in the jawbones to reposition them into the correct alignment. Plates, screws, or wires are used to secure the bones in their new position. The surgery can take several hours and is performed under general anesthesia.
After surgery, the patient will experience swelling, bruising, and discomfort in the jaw and face. Pain medication and a liquid diet may be necessary for the first few days. Recovery time varies but typically involves several weeks of restricted diet and activity to allow the bones to heal properly.
Post-surgery, the patient will continue with orthodontic treatment to fine-tune the bite alignment and ensure optimal results. Regular follow-up appointments with the surgeon and orthodontist are necessary to monitor healing progress and address any issues that may arise.
Overall, the entire process from initial consultation to final results can take several months to a year or more, depending on the complexity of the case. It is important for patients to follow post-operative instructions carefully and attend all follow-up appointments to ensure a successful outcome.
What to Ask Your Doctor
What are the potential risks and complications associated with orthognathic surgery, particularly in relation to temporomandibular disorders (TMD)?
How will my jaw joint (condyle) be positioned during and after surgery, and how does this affect the risk of developing TMD?
Are there any specific factors, such as teeth grinding, oral function problems, or psychological factors, that could impact the success of the surgery in relation to TMD?
How will you evaluate my jaw joint before surgery to ensure that I am not at a higher risk for developing joint complications post-surgery?
Are there any alternative treatments or therapies that could be considered for my condition before opting for orthognathic surgery?
What is your experience and success rate with orthognathic surgery in relation to TMD, and do you have any specific techniques or approaches that you use to minimize the risk of joint complications?
How long is the recovery process after orthognathic surgery, and how will this impact my jaw joint function and potential development of TMD?
Are there any specific post-operative care instructions or exercises that I should follow to promote proper healing and reduce the risk of joint complications?
Will I need to follow up with a specialist, such as a TMJ specialist, after surgery to monitor my jaw joint health and address any potential complications?
How will you work with me to create a personalized treatment plan that takes into account my individual risk factors and concerns related to TMD?
Reference
Authors: Robin O, Coste A. Journal: Orthod Fr. 2021 Dec 1;92(4):381-390. doi: 10.1684/orthodfr.2021.63. PMID: 34911676