外科的矯正治療を適用した１００症例における顎関節症状の長期変化

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Aim: The purpose of this study was to evaluate the longitudinal changes of TMD symptoms following orthognathic surgery.Material and methods: Questionnaires of 100 patients with jaw deformities (60 females and 40 males, mean age of 21.2 years old) taken at four stages: pre-treatment, just before surgery, post treatment, and under retention (mean retention term of 3.1 years) were used to evaluatelongitudinal changes of TMD symptoms. The answer for each question including noise, pain and difficulty in jaw movement was scored (TMD score): one point for “yes” and zero point for “no”. Based on the reported symptoms before treatment, patients were divided into two groups: symptomatic group andasymptomatic group. Thesymptomatic group was subdivided into the following threegroups according to severity of TMD symptoms: 1) Mild type group (TMD score: 1), 2) Moderate type group (TMD score: 2), 3) Severe type group (TMD score: 3).Increaseordecrease of the score in the two groups was evaluated during the presurgicaltreatment, post-surgical treatment, retention and whole treatment, respectively.Furthermore, potential etiologic factors such as age, gender, treatment term, type of malocclusion, surgical method, tooth extraction and change of overbite and overjet were statistically anaanalyzed for association with the changes in TMD symptoms.Results: Seventy-one patients out of 100 were symptomatic patients and 29 were asymptomatic patients. During the whole term, 49.3% of the symptomatic group showed a decreaseof the score, 9.9% an increase of the score and 40.8% no change of the score. Onthe other hand, 20.6% of the asymptomatic group showed an increase of the score and 79.4% no change of the score. At each term in the symptomatic group, the severe type group showed a larger decrease of the score than themoderate and mild type groups. Significant differences were also found in the change of individualTMD symptoms between the symptomatic and asymptomatic groups at each term. No statistically significant relation was found between potential etiologic factors and the change of TMD symptoms.Conclusions: Significantly different aspects were recognized in the change of TMD symptoms between the symptomatic and asymptomatic groups.In the symptomatic group, frequency of TMD improvement became higher in inverse proportion to the severity of TMD, but etiological factors causing TMDwere not recognized.