Condylar and temporomandibular joint disc positions after mandibular osteotomy for prognathism

Abstract

Purpose: The purpose of this study was to compare the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) with and without a Le Fort I osteotomy. Patients and Methods: Of 43 patients with a diagnosed jaw deformity, 20 underwent IVRO without internal fixation and 23 underwent SSRO with rigid internal fixation. Some operations were performed in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including the disc position, were assessed preoperatively and postoperatively using magnetic resonance imaging (MRI) and axial cephalography. Results: A significant difference in the direction of condylar rotation was seen in horizontal axial cephalographia images (P <.01). Fewer or no TMJ symptoms were reported postoperatively by 88% of the patients who underwent IVRO with or without a Le Fort I osteotomy and by 66.7% of patients who underwent SSRO with or without a Le Fort I osteotomy. In sagittal images, no change was seen in anterior disc displacement after SSRO; however, improvement was seen in 44.4% of patients with anterior disc displacement who underwent IVRO with or without a Le Fort I osteotomy. Conclusion: These results suggest that SSRO does not improve anterior disc displacement; IVRO improves anterior disc displacement in the initial postsurgical period, and both procedures may improve TMJ symptoms. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1424-1432, 2002