Abstract
The sagittal split ramus osteotomy is a key approach for treating dentofacial deformities. Although it delivers excellent results, the sagittal split ramus osteotomy is believed to induce stress to the temporomandibular joint. Potential stress inducers could be classified as intra- and postoperative factors resulting in an inflammatory response and molecular cascades, which initiate physiological remodeling. Occasionally, this process exceeds its capacity and causes pathological remodeling, through either degenerative joint disease or condylar resorption. Hard evidence on how orthognathic surgery causes inflammation and how this inflammation is linked to the spectrum of remodeling remains scarce. Current concepts on this matter are mainly based on clinical observations and molecular mechanisms are extrapolated from fundamental research in other body parts or joints. This perspective study provides an overview of current knowledge on molecular pathways and biomechanical effects in temporomandibular joint remodeling. It provides research directions that could lead to acquiring fundamental evidence of the relation of orthognathic surgery and inflammation and its role in remodeling. Performing osteotomies in animal models and identifying inflammatory mediators as well as their effect on the joint seem promising. Patients affected by pathological remodeling can also provide samples for histological as well as molecular analysis. Individual susceptibility analysis by linking certain suspect phenotypes to genetic variation could identify the cause and molecular pathway responsible for degenerative joint disease and condylar resorption, ultimately leading to clinically applicable treatment and prevention strategies.
Highlights
Orthognathic surgery plays a crucial role in the treatment of dentofacial deformities
This study provides hypotheses on how orthognathic surgery causes biomechanical stress at the temporomandibular joint (TMJ) and how this stress can initiate inflammation in the TMJ
The actual molecular pathways of these entities and their link with inflammation caused by orthognathic surgery should provide further insight into these questions
Summary
Orthognathic surgery plays a crucial role in the treatment of dentofacial deformities. It is believed that the SSRO causes biomechanical stress at the TMJ This biomechanical stress leads to a process frequently observed on follow-up imaging called physiological joint remodeling (Hoppenreijs et al, 1998; de Assis Ribeiro Carvalho et al, 2010; Catherine et al, 2016; Gomes et al, 2017; Xi et al, 2017; Vandeput et al, 2019). Postoperative condylar resorption rates range from 1 to 31% (Catherine et al, 2016; Mousoulea et al, 2016) These pathological remodeling processes have a similar origin, but they evolve into distinct entities through molecular pathways yet unknown. It provides possible links between inflammation and the remodeling spectrum of the joint. Research directions are suggested to test these hypotheses
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