Morphologic and clinical changes in the temporomandibular joint following orthognathic surgery

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1 Journal of Advanced Clinical & Research Insights (2015), 2, ORIGINAL ARTICLE Morphologic and clinical changes in the temporomandibular joint following orthognathic surgery Archana Louis, S. M. Kotrashetti, Indraniil Roy, Poornima Kadagad Department of Oral and Maxillofacial Surgery, KLE S VK Institute of Dental Sciences, Belgaum, Karnataka, India Keywords Condyle, oral surgery, orthognathic surgery, temporomandibular joint Correspondence Dr. Indraniil Roy, Department of Oral and Maxillofacial Surgery, KLE S VK Institute of Dental Sciences, Belgaum, Karnataka, India. Phone: , dr.indraniilroy@gmail.com Received 04 September 2014; Accepted 02 November 2014 doi: /ins.jcri.45 Abstract Background: Temporomandibular joint (TMJ) health is closely related to occlusion of an individual. The change in occlusion following orthognathic surgery is expected to cause changes in the TMJ. Aims and Objectives: The aim of this study is to assess the clinical, symptomatic and radiological changes in TMJ 1 year following orthognathic surgery. Materials and Methods: This study was carried out in Department of Oral and Maxillofacial Surgery, KLE s VK Institute of Dental Sciences. Twenty patients were included. All patients were assessed at 1 year follow up for any clinical changes in TMJ, orthopantamograph was taken to analyze condition of condyle and the patients filled a questionnaire regarding TMJ symptoms. Results: Clinical examination of all 20 patients showed improvement in the TMJ functioning. Radiographic analysis shows there was remodeling of both condyles in all patients. Fifteen of the 20 patients perceived an improvement in their TMJ symptoms. Conclusion: This study suggests that there is the overall improvement in the TMJ and is closely affected by the orthognathic surgery. Introduction Functional disturbances and esthetic considerations are the reasons for patients to seek treatment for dento facial deformities. Functional disorders may include signs and symptoms of temporomandibular disorders (TMD), such as joint pain, chewing problems, joint noises, headaches, etc. Skeletal stability following orthognathic surgery has been a subject of numerous investigations. Several authors have presented evidence of the relation between orthognathic surgery and condylar remodeling and various changes. [1 5] Condylar resorption was first reported by Burke in [6] Changes in the mandibular condyles after orthognathic surgery either in form of resorption or remodeling is sequel, which has been noted both clinically as well as radiographically. [7] Although a definite cause has not been established, various hypothesis have been stated in the literature regarding this. The term progressive condylar resorption (PCR) was coined by Arnett and Tamborello. [8] The bilateral sagittal split osteotomy may cause alteration of the position of the condyle in the fossa. The medio lateral torqueing or posterior positioning of the condyle after rigid fixation might be associated with condylar resorption and late relapse. [9] PCR is a serious complication that gives rise to frustration for both the patient and the clinician. Condylar changes are seen in terms of progressive alteration of condylar shape and decrease in mass. As a result, patients may exhibit a decrease in posterior facial height and retrognathism. Although the cause is unknown, condylar resorption has been associated with various systemic diseases, trauma, neoplasia, orthodontic treatment, and orthognathic surgery. [7] The adaptive changes in the condyle as a result of alteration in mechanical loading have been discussed in previous studies. [7,10] In the mandibular condyle, occlusal alterations and the consequent mechanical stimulus induces the fibrocartilage to enter into an activated state, thus resulting in the proliferation of chondroblasts and osteoblasts in the condyle. This enables the adaptive remodeling, which helps the temporomandibular joint (TMJ) to adjust to the altered biomechanical environment. [11,12] Signs of TMJ disorders before and after orthognathic surgery have been documented in several clinical studies, but the reported incidence varies widely. There are reports of various degrees of improvement [1] or deterioration, [2] or no change at all, [3] in TMJ symptoms after orthognathic surgery. 54 Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr 2015

2 Louis, et al. Morphologic and clinical changes in the TMJ following orthognathic surgery The patient s rating of outcome might not correlate with those of clinicians. The patients who are the most satisfied with the treatment outcome are those whose aesthetics and occlusion improve and whose TMD symptoms are relieved. [13] Many studies showed relief or stability in signs and symptoms of TMJ, [4] however the development of TMD symptoms in pre operatively asymptomatic patients as also been reported. [5] Misaligned occlusion might bring about condylar resorption. kinds of occlusion are present outside of Angle classification: (1) Stable and (2) unstable. [14 18] A stable occlusion will not deflect the condyle placement throughout interdigitation of the dentition (irrespective of Angle classification). An unsound occlusion creates compression deflection of the condyle throughout interdigitation of the teeth (irrespective of Angle classification). [3,19] Numerous research indicates that the posteriorization of the mandibular condyle additional to occlusal changes (i.e., volatile occlusion) can lead to postglenoid spinal column and posterior condylar resorption. [20 28] Class I occlusion along with condylar compression is actually, by description, an unsound occlusion. [29 33] Correction (orthodontics, orthognathic surgery, prosthetics) regarding occlusal inaccuracy to a Class I dental relationship, in the event that it is related to joint compression, may bring about condylar resorption. [34 37] Arnett and Tamborello have noticed condylar resorption whenever a class I occlusion had been created with the mandibular condyles posterior and/or torqued throughout orthognathic surgical treatment. [38] Orthodontic and prosthodontic treatment could alter condylar position, even though usually never to the identical level as that witnessed subsequent orthognathic surgery. Consequently, these non surgical methods might give rise to significant condylar remodeling, specifically in vulnerable individuals (i.e., individuals prone to more hostile tissue reaction supplementary to host factors. In this retrospective study, we have evaluated the changes in the TMJ, 1 year following orthognathic surgery. The TMJ has been evaluated for clinical and radiologic changes and the patient satisfaction following orthognathic surgery has also been assessed. Materials and Methods The required data for the study was collected from medical and dental records of 20 patients who underwent orthognathic surgery for the correction of their dentofacial abnormalities at KLE s VK Institute of Dental Sciences, Belgaum. Patients with all records available, who could be contacted and could come for follow up, with minimum 1 year follow up and who were willing to give consent were included in this study. A list of all patients of dentofacial anomalies treated by orthognathic surgery at KLE P.K Hospital was made. The records of the patients who fulfilled the inclusion criteria were checked and the proforma [Table 1] was filled for each patient. Patients were then recalled to the department and clinical examination of the TMJ was done. For radiographic evaluation, an orthopantamograph (OPG) was advised which was evaluated for any condylar resorption. The patients were also given a self designed questionnaire [Table 2] to assess patient s perceptions on the signs and symptoms of TMD before and after surgery. Consent for inclusion in this study was obtained from each patient. For radiographic assessment the Kodak 8000c, Digital Panaromic and Cephalometric system software was used. With the aid of this software, a ramus tangent and a line drawn perpendicular to it through the most superior point of the condyle Table 1: Patient case history and examination proforma Name: Age: Sex: Medical history: Dental history: Local examination: TMJ pain/tenderness TMJ sounds Mouth opening Occlusion Over jet Overbite Skeletal abnormality Diagnosis: Surgery planned: Intraoperative records Surgery performed: Postoperative records: TMJ pain/tenderness TMJ sounds Mouth opening Occlusion Over jet Overbite TMJ: Temporomandibular joint Table 2: Kranjenbrink classification of TMJ Type A The condyle has height to width ratio equal to or <1. The top of the condyle is situated posterior of the horizontal midpoint Type B The condyle has height to width ratio >1. The top of the condyle is situated posterior of the horizontal midpoint. The superior part of the condylar neck is curved posteriorly Type C The condyle has height to width ratio >1. The top of the condyle is situated at the horizontal midpoint. The condyle has a rounded superior surface Type D The condyle has height to width ratio >1. The top of the condyle is situated anterior of the horizontal midpoint. The superior part of the condylar neck is curved anteriorly Type E Spiky and finger shaped condyle on which the most protruding point cannot be identified TMJ: Temporomandibular joint Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr

3 Morphologic and clinical changes in the TMJ following orthognathic surgery Louis, et al. were drawn. The distance from the top of the condyle to the inferior point of tangency was measured as ramus height. Next the contour of the condyle is assessed. The condyle is defined by the tangent to the posterior border of the condylar neck (Y axis) and a line drawn perpendicular to the condyle tangent through the broadest point of the condyle (X axis). The top of the condyle is related to the midpoint on the X axis. The contour of the condyle is determined by the condylar height (H) to width (W) ratio and the location of the top. The surface of the condyle was subdivided in an anterior, superior and posterior part. The classification of Kranjenbrink was modified as in Table 2. [24] This classification has been illustrated in Figure 1. Based on the condylar condition on OPG, it was then classified into 3 types: No condylar changes Condylar remodeling Condylar resorption. Condylar remodeling is characterized by morphologic changes, but with stable ramus height not leading to relapse. The inclusion criteria is as follows: Minor bone resorption and/or bone apposition on one of the condylar sites and the change of the condylar contour from a less favorable one to a more favorable one. Figure 1: Schematic presentation of the radiographic evaluation on the orthopantamograph Ramus height, as measured on radiographs at the one year or long term follow up, compared with the pre or immediately postoperative radiographs should differ less than or equal to 6%. Condylar resorption is characterized by severe morphologic changes with decreased condylar configuration and volume, and decreased ramus height, therefore leading to relapse. The inclusion criteria are as follows: Major bone resorption with or without bone apposition and reduction of condylar contour and volume and the change of the condylar contour from a favorable one to a less favorable one. Ramus height as measured on radiographs at one year or long term follow up compared with the pre or immediately postoperative ones should differ more than 6%. For the evaluation of patient perception, the patients were given a questionnaire [Table 3] to be filled to assess the effect on TMJ symptoms following orthognathic surgery. The protocol was reviewed by the appropriate Institutional Review Board, is in compliance with the Helsinki declaration, and each subject in the project has signed a detailed informed consent form. Results This study included 20 patients of which 12 were male, and 8 were female. The mean age of the patient at the time of surgery was years. There were 2 cleft patients included in the study. Of the 20 patients, 8 underwent bilateral sagittal split osteotomy, 5 Lefort I and 7 underwent Bijaw Surgery. Table 4 shows the distribution of study samples by treatment given and gender. Clinical examination of all 20 patients showed an improvement in the TMJ functioning at a 1 year follow up visit as shown in Table 5. Comparison of the OPG taken at 1 year follow up visit with preoperative OPG showed that there was remodeling of both the condyles seen in all 20 patients as shown in Table 6. The results of our study also revealed that 15 of the 20 patients (75%) perceived an improvement in their TMJ symptoms 1 year following orthognathic surgery as shown in Table 7. Table 3: Patient questionairre for TMJ symptoms Questions Before surgery After surgery Yes No Same Improved Worsened Did you have TMJ make noise Did you feel pain in TMJ Did you have limited mouth opening before surgery? Did you experience TMJ locking Did you notice open mouth deformity Did you have deviation of mandible while opening mouth How do you judge your TMJ symptoms and feeling after surgery as compared to before the surgery TMJ: Temporomandibular joint 56 Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr 2015

4 Louis, et al. Morphologic and clinical changes in the TMJ following orthognathic surgery Table 4: Distribution of study samples by treatment given and gender Treatment given Male (%) Female (%) Total (%) BSSO 7 (87.50) 1 (12.50) 8 (40.00) Lefort 1 3 (60.00) 2 (40.00) 5 (25.00) Lefort I and BSSO 2 (28.57) 5 (71.43) 7 (35.00) Total 12 (60.00) BSSO: Bilateral sagital split osteotomy Discussion 8 (40.00) 20 (100.00) Table 5: Clinical changes seen in patients 1 year following orthognathic surgery Age/sex TMJ tenderness TMJ sounds Mouth opening (finger width) Deviation Overall Pre Post Pre Post Pre Post Pre Post 18 y/m P A P A 3½ 4 P A Improvement 23 y/m P A P A 3½ 4 A A Improvement 19 y/f P A A A 2½ 3½ A A Improvement 18 y/m A A P A 3 4 P A Improvement 20 y/f P A A A 3½ 4 A A Improvement 20 y/m P A P A 3 4 P P Improvement 22 y/m P P A A 3½ 4 P A Improvement 21 y/m P A A P 3 4 A A Improvement 25 y/f P A A A 2½ 3½ P A Improvement 24 y/f P A P A 3½ 3½ P A Improvement 21 y/m P A P A 3 4 A A Improvement 21 y/m A A A A 3 4 A A Improvement 20 y/f P A A A 2½ 3½ P P Improvement 20 y/m P A P A 2½ 4 A A Improvement 23 y/m A A P A 3 4 A A Improvement 21 y/f A A A A 3½ 4 P A Improvement 21 y/f A A A A 2½ 4 P A Improvement 21 y/f P A A A 3 3½ A A Improvement 20 y/m A A A A 3½ 4 A A Improvement 18 y/m A A P A 3 4 A A Improvement P: Present, A: Absent, TMJ: Temporomandibular joint There has been a considerable amount of research conducted to improve our understanding of growth and adaptation of the TMJ in response to orthognathic surgery. [12,38 41] The healthy TMJ is responsive to changes in its biomechanical and biophysical environment. Exposed to such changes, the TMJ may undergo substantial remodeling, an adaptive capacity not shared by many other joints. [42] Compressive forces on the TMJ have been shown to cause local changes in articular cartilage and in the condyle. [43] Damage to the TMJ alters its physical properties and further affects its ability to withstand compressive and shearing forces. The risks and the degree of severe degenerative changes in the TMJ after orthognathic surgical interventions in the mandible have been documented. [44,45] Occlusal instability/discrepancy is mentioned as one of the several etiologic factors behind TMDs. [14] Such suboptimal occlusion, based on skeletal divergence, is also an apparent reason to seek or carry out orthognathic surgery. [46] Thus, one would assume that TMD would be rather pronounced among orthognathic surgery patients, and that TMD in such patient groups would decrease after orthognathic surgery. However, there exist two schools of thought. Some authors suggest that orthognathic surgical procedures can help in the reduction of TMJ dysfunction, [47,48] while others have shown that orthognathic surgery in such patients can causes further deleterious effects on the TMJ. [4,20] In our study, we have studied the changes in TMJ in 20 patients, one year following orthognathic surgery. The TMJ was evaluated for clinical and radiological changes. The patients perception 1 year following surgery has also been assessed. Clinical examination of all 20 patients showed an improvement in the TMJ functioning at the 1 year follow up visit which is in accordance with the studies by Karabouta et al. and Magnusson et al. who suggest that there is improvement in the TMJ functioning, signs and symptoms following orthognathic surgery. [47,48] Comparison of the OPG taken at 1 year follow up visit with preoperative OPG showed that there was remodeling of both the condyles seen in all 20 patients, which are in accordance to the study by Hoppenreijs et al. [23] However this finding in our study is in contrast to the studies by Wohlwender et al. who suggested that resorption of the TMJ is noticed following orthognathic surgery [37] with the maximum resorption occurring between 6 months and 1 year. The results of our study also revealed that 15 of the 20 patients (75%) perceived an improvement in their TMJ symptoms 1 year following orthognathic surgery. One of the concepts concerning the etiology and pathogenesis of osteoarthrosis includes a mechanical factor implying overloading. [49] Different types of mechanical forces during and after surgery can be distinguished. Compressive forces of the condyle in the articular fossa could occur due to autorotation of the mandible (biomechanical loading), positioning of condyles in the glenoid fossa during surgery (surgical loading), distortion of condylar position by osteosynthesis (mechanical loading) and postoperative tension of muscles, periosteum and ligaments (soft tissue loading). [24] The type of internal fixation is also an important treatment factor in condylar morphologic changes. Circulation of synovial fluid and thus, nutrition, is less compromised when rigid internal fixation is used and, therefore, the adaptive capacity is probably better than in the wire fixation and IMF group. Rigid internal fixation appears to reduce the incidence of condylar resorption and allows healthy remodeling to take place. [28,34] Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr

5 Morphologic and clinical changes in the TMJ following orthognathic surgery Louis, et al. Table 6: Radiographic changes seen in OPG 1 year following orthognathic surgery Patients number Ramus height Condyle contour Overall Pre Post Pre Post Left Right Left Right Left Right Left Right Type D Type D Type C Type D Remodelling Type C Type D Type C Type C Remodelling Type D Type D Type C Type C Remodelling Type D Type E Type D Type D Remodelling Type D Type D Type C Type C Remodelling Type D Type D Type C Type C Remodelling Type C Type D Type C Type C Remodelling Type D Type D Type C Type C Remodelling Type D Type C Type C Type C Remodelling Type D Type D Type C Type D Remodelling Type C Type D Type C Type C Remodelling Type C Type C Type B Type C Remodelling Type D Type D Type C Type C Remodelling Type D Type C Type C Type C Remodelling Type D Type C Type C Type C Remodelling Type B Type C Type B Type B Remodelling Type D Type C Type C Type C Remodelling Type C Type D Type C Type C Remodelling Type C Type D Type C Type C Remodelling Type D Type D Type C Type C Remodelling OPG: Orthopantamograph TMJ symptoms and internal derangement are commonly found in patients with dentofacial deformities. In the majority of those patients, the improvement or resolution of joint symptoms following orthognathic surgical procedure, has been observed. The exact mechanism for improvement of TMJ symptoms after orthognathic surgery is still unclear. An explanation for this outcome is based on the hypothesis that the disk condyle relationship will be altered favorably by a change in the position of the condyle. [50,51] Another hypothesis is that due to the normal occlusion achieved by means of surgery, there is no stress on the TMJ resulting in an improvement of the TMJ functioning and symptoms. [48] Olsson and Laskin (1980) stated that the dissatisfaction with surgery was related to inadequate explanation of the procedures, rather than the actual outcome. It is therefore of critical importance to ensure that the patients are adequately prepared for the surgical procedure, the post operative period, and the outcome. It is quite clear that false expectations can lead to patient resentment. [52] In our study, all 20 patients were treated using a standard protocol. Each patient initially underwent a thorough clinical examination and orthodontic consultation. The Dolphin software was used in our entire 20 patient as an adjuvant to aid in treatment planning. Each case was discussed with the orthodontist, and the diagnosis and treatment planning was then made based on the expertise of both the oral and maxillofacial surgeon and the orthodontist. The patient was then called for the next appointment where the diagnosis and the treatment plan were discussed with the patient in the presence of both the orthodontist and the maxillofacial surgeon. He/She then underwent presurgical orthodontics. Once decompensation was achieved, the patient was planned for surgery. Impressions were then made and poured. Following face bow transfer, the casts were articulated on to semi adjustable articulators. Model surgery was then performed, and the surgical splint was fabricated. In all 20 patients included in our study, these surgical splints were used intraoperatively to guide in the movement of the maxilla and/or mandible. The surgical splint also aids in maintaining the desired occlusion while the osteotomised segments were fixed. In all our 20 patients, rigid internal fixation was used. The final refinement of the occlusion was then carried out with postsurgical orthodontics. In our opinion, the absence of condylar resorption and the improvement in the TMJ functioning seen in all our patients included in our study, could be attributed to the strict and meticulous protocol employed by us. The surgical splint that is 58 Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr 2015

6 Louis, et al. Morphologic and clinical changes in the TMJ following orthognathic surgery Table 7: Patient perception of TMJ symptoms 1 year following orthognathic surgery Joint sounds Joint pain Limited mouth opening TMJ locking Open mouth deformity Deviation Overall Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post P P A A A A A A A A P P No change P A P A P A A A A A P A Improvement A P P P A P A A A A A P Detoriation A A A A A A A A A A P P No change P A P A P A A A A A A A Improvement A A P A P A A A A A P A Improvement P A A A P A A A A A P A Improvement P A A A A A A A A A P A Improvement P A P A P A A A A A P A Improvement P P A A A A A A A A P P No change P A A A A A P A A A P A Improvement A P A P P P A A A A A P Detoriation A A P A P A A A A A P A Improvement P A A A P A A A A A P A Improvement A A P A P A A A A A P A Improvement P: Present, A: Absent, TMJ: Temporomandibular joint fabricated for each patient serves as a template for guiding the surgeon to provide the patient with adequate occlusion. Mini plate osteosynthesis used by us for fixation provides adequate rigid internal fixation and thus improves the adaptive capacity of the condyle as proved by various studies. Another important factor to be considered is a good understanding by the patient of his dentofacial skeletal problems as well as what to expect during and after his treatment. This reduces the false expectations of the patient. A standard pre operative consultation followed at our set up could be the reason why 75% of our patient perceived an improvement in TMJ functions following orthognathic surgery. References 1. De Clercq CA, Abeloos JS, Mommaerts MY, Neyt LF. Temporomandibular joint symptoms in an orthognathic surgery population. J Craniomaxillofac Surg 1995;23: Hori M, Okaue M, Hasegawa M, Harada D, Kamogawa D, Matsumoto M, et al. Worsening of pre existing TMJ dysfunction following sagittal split osteotomy: A study of three cases. J Oral Sci 1999;41: Onizawa K, Schmelzeisen R, Vogt S. Alteration of temporomandibular joint symptoms after orthognathic surgery: Comparison with healthy volunteers. J Oral Maxillofac Surg 1995;53: Wolford LM, Reiche Fischel O, Mehra P. Changes in temporomandibular joint dysfunction after orthognathic surgery. J Oral Maxillofac Surg 2003;61: Pahkala R, Heino J. Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy two patients. Acta Odontol Scand 2004;62: Burke PH. A case of acquired unilateral mandibular condylar hypoplasia. Proc R Soc Med 1961;54: Kohn MW. Analysis of relapse after mandibular advancement surgery. J Oral Surg 1978;36: Arnett GW, Tamborello JA. Progressive class II development: Female idiopathic condylar resorption. Oral Maxillofac Surg Clin North Am 1990;2: Arnett GW, Milam SB, Gottesman L. Progressive mandibular retrusion Idiopathic condylar resorption. Part I. Am J Orthod Dentofacial Orthop 1996;110: Kawamata A, Fujishita M, Nagahara K, Kanematu N, Niwa K, Langlais RP. Three dimensional computed tomography evaluation of postsurgical condylar displacement after mandibular osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85: McNamara JA Jr, Bookstein FL, Shaughnessy TG. Skeletal and dental changes following functional regulator therapy on class II Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr

7 Morphologic and clinical changes in the TMJ following orthognathic surgery Louis, et al. patients. Am J Orthod 1985;88: Ellis E 3 rd, Hinton RJ. Histologic examination of the temporomandibular joint after mandibular advancement with and without rigid fixation: An experimental investigation in adult Macaca mulatta. J Oral Maxillofac Surg 1991;49: Pahkala RH, Kellokoski JK. Surgical orthodontic treatment and patients functional and psychosocial well being. Am J Orthod Dentofacial Orthop 2007;132: Magnusson T, Ahlborg G, Finne K, Nethander G, Svartz K. Changes in temporomandibular joint pain dysfunction after surgical correction of dentofacial anomalies. Int J Oral Maxillofac Surg 1986;15: Kerstens HC, Tuinzing DB, Golding RP, van der Kwast WA. Condylar atrophy and osteoarthrosis after bimaxillary surgery. Oral Surg Oral Med Oral Pathol 1990;69: Westesson PL, Dahlberg G, Hansson LG, Eriksson L, Ketonen L. Osseous and muscular changes after vertical ramus osteotomy. A magnetic resonance imaging study. Oral Surg Oral Med Oral Pathol 1991;72: Garvill J, Garvill H, Kahnberg KE, Lundgren S. Psychological factors in orthognathic surgery. J Craniomaxillofac Surg 1992;20: De Clercq CA, Neyt LF, Mommaerts MY, Abeloos JV, De Mot BM. Condylar resorption in orthognathic surgery: A retrospective study. Int J Adult Orthodon Orthognath Surg 1994;9: Bouwman JP, Kerstens HC, Tuinzing DB. Condylar resorption in orthognathic surgery. The role of intermaxillary fixation. Oral Surg Oral Med Oral Pathol 1994;78: Feinerman DM, Piecuch JF. Long term effects of orthognathic surgery on the temporomandibular joint: Comparison of rigid and nonrigid fixation methods. Int J Oral Maxillofac Surg 1995;24: Egermark I, Blomqvist JE, Cromvik U, Isaksson S. Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery. Eur J Orthod 2000;22: Fernández Sanromán J, Gomez Gonzalez JM, Alonso Del Hoyo J, Monje Gil F. Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: A magnetic resonance imaging and computed tomography prospective study. J Craniomaxillofac Surg 1997;25: Hoppenreijs TJ, Freihofer HP, Stoelinga PJ, Tuinzing DB, van t Hof MA. Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite. A clinical and radiological study. Int J Oral Maxillofac Surg 1998;27: Cutbirth M, Van Sickels JE, Thrash WJ. Condylar resorption after bicortical screw fixation of mandibular advancement. J Oral Maxillofac Surg 1998;56: De Clercq CA, Neyt LF, Mommaerts MY, Abeloos JS. Orthognathic surgery: Patients subjective findings with focus on the temporomandibular joint. J Craniomaxillofac Surg 1998;26: Ueki K, Nakagawa K, Takatsuka S, Yamamoto E. Condylar changes after contralateral mandibular osteotomy in the rabbit. J Craniomaxillofac Surg 1999;27: Panula K, Somppi M, Finne K, Oikarinen K. Effects of orthognathic surgery on temporomandibular joint dysfunction. A controlled prospective 4 year follow up study. Int J Oral Maxillofac Surg 2000;29: Hu J, Wang D, Zou S. Effects of mandibular setback on the temporomandibular joint: A comparison of oblique and sagittal split ramus osteotomy. J Oral Maxillofac Surg 2000;58: Aghabeigi B, Hiranaka D, Keith DA, Kelly JP, Crean SJ. Effect of orthognathic surgery on the temporomandibular joint in patients with anterior open bite. Int J Adult Orthodon Orthognath Surg 2001;16: Hwang SJ, Haers PE, Seifert B, Sailer HF. Non surgical risk factors for condylar resorption after orthognathic surgery. J Craniomaxillofac Surg 2004;32: Mavreas D, Athanasiou AE. Tomographic assessment of alterations of the temporomandibular joint after orthognathic surgery. Eur J Orthod 1992;14: Katsumata A, Nojiri M, Fujishita M, Ariji Y, Ariji E, Langlais RP. Condylar head remodeling following mandibular setback osteotomy for prognathism: A comparative study of different imaging modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101: Zhao Q, Hu J, Wang D, Zhu S. Changes in the temporomandibular joint after mandibular setback surgery in monkeys: Intraoral vertical versus sagittal split ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104: Abrahamsson C, Ekberg E, Henrikson T, Nilner M, Sunzel B, Bondemark L. TMD in consecutive patients referred for orthognathic surgery. Angle Orthod 2009;79: Dujoncquoy JP, Ferri J, Raoul G, Kleinheinz J. Temporomandibular joint dysfunction and orthognathic surgery: A retrospective study. Head Face Med 2010;6: Ramieri G, Piancino MG, Frongia G, Gerbino G, Fontana PA, Debernardi C, et al. Clinical and instrumental evaluation of the temporomandibular joint before and after surgical correction of asymptomatic skeletal class III patients. J Craniofac Surg 2011;22: Wohlwender I, Daake G, Weingart D, Brandstätter A, Kessler P, Lethaus B. Condylar resorption and functional outcome after unilateral sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112: Jin Hyun J, Choi SK, Park SH, Kim JW. Clinical evaluation of temporomandibular joint disorder after orthognathic surgery in skeletal class II malocclusion patients. J Korean Assoc Oral Maxillofac Surg 2012;38: Carlsson GE, Oberg T. Remodelling of the temporomandibular joints. Oral Sci Rev 1974;6: McNamara JA Jr, Hinton RJ, Hoffman DL. Histologic analysis of temporomandibular joint adaptation to protrusive function in young adult rhesus monkeys (Macaca mulatta). Am J Orthod 1982;82: Eckerdal O, Sund G, Astrand P. Skeletal remodelling in the temporomandibular joint after oblique sliding osteotomy of the mandibular rami. Int J Oral Maxillofac Surg 1986;15: Moffett BC, Johnson LC, McCabe JB, Askew HC. Articular remodelling in the adult human temporomandibular joint. Am J Anat 1964;115: Luz JG, Jaeger RG, de Araújo VC, de Rezende JR. The effect of indirect trauma on the rat temporomandibular joint. Int J Oral Maxillofac Surg 1991;20: Phillips RM, Bell WH. Atrophy of mandibular condyles after sagittal ramus split osteotomy: Report of case. J Oral Surg 1978;36: Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr 2015

8 Louis, et al. Morphologic and clinical changes in the TMJ following orthognathic surgery 45. Rotskoff KS. Consequence of orthognathic surgery for the temporomandibular joint. Oral Maxillofac Clin North Am 1989;1: Athanasiou AE, Melsen B, Eriksen J. Concerns, motivation, and experience of orthognathic surgery patients: A retrospective study of 152 patients. Int J Adult Orthodon Orthognath Surg 1989;4: Karabouta I, Martis C. The TMJ dysfunction syndrome before and after sagittal split osteotomy of the rami. J Maxillofac Surg 1985;13: Magnusson T, Ahlborg G, Svartz K. Function of the masticatory system in 20 patients with mandibular hypo or hyperplasia after correction by a sagittal split osteotomy. Int J Oral Maxillofac Surg 1990;19: De Bont LG, Stegenga B. Pathology of temporomandibular joint internal derangement and osteoarthrosis. Int J Oral Maxillofac Surg 1993;22: Bell WH, Yamaguchi Y, Poor MR. Treatment of temporomandibular joint dysfunction by intraoral vertical ramus osteotomy. Int J Adult Orthodon Orthognath Surg 1990;5: Bell WH, Yamaguchi Y. Condyle position and mobility before and after intraoral vertical ramus osteotomies and neuromuscular rehabilitation. Int J Adult Orthodon Orthognath Surg 1991;6: Olsson RE, Laskin DM. Expectations of patients from Orthognathic surgery. J Oral Surg 1980;36: How to cite this article: Louis A, Kotrashetti SM, Roy I, Kadagad P. Morphologic and clinical changes in the temporomandibular joint following orthognathic surgery. J Adv Clin Res Insights 2015;2: Journal of Advanced Clinical & Research Insights Vol. 2:2 Mar-Apr

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