Temporomandibular Disc Research Articles

Change of lateral pterygoid muscle and temporomandibular disc position after bi-maxillary surgery in class II and III patients.

The purpose of this study was to examine changes in lateral pterygoid muscle and temporomandibular joint (TMJ) disc position in classes II and III patients, before and after bi-maxillary surgery. The subjects were comprised of 48 patients (96 sides), 23 of whom were diagnosed as class II and 25 as class III patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO). The cross-sectional measurements of the lateral pterygoid muscles were measured at two levels of horizontal plane images (condyle and mandibular notch levels) by computed tomography (CT), before and 1year after the operation. The relationship between these measurements regarding lateral pterygoid muscle and disc position by magnetic resonance image (MRI) was also examined statistically. Preoperatively, class II was significantly larger than class III in condylar angle at the upper level and in long diameter, square, condylar angle, and muscle angle at the lower level (P < 0.05). After 1year, class II was significantly larger than class III in condylar angle, long diameter, and muscle angle at the upper level and in long diameter, short diameter, square, condylar angle, and muscle angle at the lower level (P < 0.05). TMJ disc position classification correlated significantly with condylar angle at the upper level and long diameter and condylar angle at the lower level (P < 0.0001). This study suggested that there were differences in the cross-sectional measurements of the lateral pterygoid muscles between class II and class III patients, before and after bi-maxillary surgery.

Evaluation of Pain Regression in Patients with Temporomandibular Disc Displacement with Reduction Treated by Intra-Articular Platelet-Rich Plasma Injections versus Arthrocentesis

Objectives: The objective of this study is to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis in Patients with Temporomandibular Disc Displacement with Reduction. Subjects and Methods: Twenty four patients who did not respond to conservative treatment of anterior disc displacement with reduction were included in this study. They were randomly allocated to one of two study arms: the 'intervention' group who treated with intra articular PRP injection or the control group who treated with Arthrocentesis. Results: In this study, both groups showed significant improvement in TMJ pain, maximum mouth opening (MMO) and clicking 2 weeks after treatment that maintained thereafter. Conclusion: It is possible to conclude that intra-articular PRP injection was equivalent to arthrocentesis regarding reduction of TMJ pain with more beneficial effects of arthrocentesis on MMO and TMJ sound.

The importance of multisection sagittal and coronal magnetic resonance imaging evaluation in the assessment of temporomandibular joint disc position

ObjectivesThe aim of this study was to evaluate diagnoses of temporomandibular (TMJ) disc displacement by comparing evaluations done on the basis of central sagittal scans only, the most often used in temporomandibular disorder (TMD) patients, with a multisection evaluation done with both sagittal and coronal scans.Materials and methodsMultisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to RDC/TMD criteria. Disc position in the intercuspal position (IP) was assessed two times using two different methods. The first method involved a TMJ disc position evaluation on the central slide in the oblique sagittal plane only. In the second method, the TMJ disc position was assessed on all oblique sagittal and coronal images. McNemar’s χ2 test was used to evaluate the differences between the sensitivities of two methods.ResultsThe first method (central oblique sagittal scans assessment) identified 148 TMJs (38.7%) with normal disc position compared with 89 TMJs (23.3%) with normal disc position found by the second method (all oblique sagittal and coronal scans assessment). The sensitivity of analysis in both planes was significantly higher than in the sagittal plane only (p < 0.001).ConclusionsThe multisection analysis in the sagittal and coronal plane allows to distinguish the correct disc position from disc displacement and thus improve evaluation of TMJ internal derangement.Clinical relevanceThe multisection sagittal and coronal images should be recommended as a standard in MRI of the TMJ disc displacement in patients with TMD to avoid false-negative diagnoses.

Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis.

This systematic review compared platelet concentrates (PCs) versus hyaluronic acid (HA) or saline/Ringer's solution injections as treatments of temporomandibular osteoarthritis and disc displacement in terms of pain and maximum mouth opening (MMO). PubMed, Cochrane, and Scopus were searched up to March 6, 2020. Inclusion criteria were randomized clinical trials (RCTs). Exclusion criteria were case series, observational studies, animal studies, and reviews. The Effective Public Health Practice Project (EPHPP) quality assessment tool was used to assess the risk of bias in the included studies. The weighted mean difference was used to compare the results. Nine RCTs were included with a total of 407 patients. The numbers of joints treated were 262, 112, and 112 in the PC, HA, and saline groups, respectively. The quality of studies was rated as strong in 4 studies, moderate in 4 studies, and weak in 1 study. The meta-analysis revealed that PCs decreased pain visual analogue scale (VAS) scores compared to HA by an average of -1.11 (CI, -1.62 to -0.60; P < 0.0001) and -0.57 (CI, -1.55 to 0.41; P = 0.26) at 3 and 12 mo follow-up respectively. Also, the average decrease in pain scores with PC compared to saline was -1.33 (CI, -2.61 to -0.06; P = 0.04), -2.07 (CI, -3.46 to -0.69; P = 0.003), and -2.71 (CI, -4.69 to -0.72; P = 0.008) at 3, 6, and 12 mo, respectively. Regarding MMO measurements, PC was comparable to HA, but it was significantly better than saline after 3 and 6 mo [2.9 mm (CI,1.47 to 4.3; P < 0.0001), and 1.69 mm (CI, 0.13 to 3.25; P = 0.03) respectively]. PC reduces pain VAS scores compared to HA during the first 3 m after treatment, and when compared to saline, it reduces pain and increases MMO for longer durations. However, due to differences between groups regarding PC preparation protocols and study heterogeneity, further standardized RCTs are required. This study provides researchers and clinicians with quantitative and qualitative analyses of the current evidence regarding the clinical outcomes of platelet concentrate injections in the treatment of temporomandibular joint osteoarthritis and disc displacement in terms of pain control and maximum mouth opening.

Association between temporomandibular joint disc position evaluated by magnetic resonance imaging and mandibular condyle inclination evaluated by computed tomography.

Temporomandibular joint disc displacement is common in the world's population and could be associated with bone and functional characteristics of the temporomandibular joint. The aim of these study was to analyse the association between temporomandibular joint disc position evaluated by magnetic resonance imaging (MRI) and the inclination of the mandibular condyle evaluated by computed tomography (CT). One hundred and seventy temporomandibular joints (TMJ) were retrospectively analysed. The temporomandibular disc position was evaluated by MRI and classified into three types: normal (N), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The mandibular condyle measurements evaluated by CT included horizontal, sagittal and coronal inclination. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between condylar inclination and disc position. There was an association between disc position and the horizontal and sagittal condylar inclination (P<.05). There are statistically significant differences in the mean of horizontal and sagittal inclination of the mandibular condyle between the DDWoR and the other disc positions (P=.002 and P=.004). Disc position was not statistical associated with coronal inclination of condyle (P>.05). These results indicate that the inclination of the mandibular condyle may be different in TMJ with various disc position. A more medial horizontal inclination and a more posterior sagittal inclination of the mandibular condyle are associated with DDWoR.

Arthroscopic discopexy technique with anchors for treatment of temporomandibular joint internal derangement: Clinical and magnetic resonance imaging evaluation

PurposeThe objective of this study was to describe a technique of arthroscopic discopexy with anchors used to treat temporomandibular joint internal derangement. Materials and methodsThis study involved patients with unilateral temporomandibular dysfunction refractory to conservative treatment, and whose magnetic resonance imaging (MRI) examinations showed internal derangement of the temporomandibular disc, with anterior disc displacement. Maximal interincisal opening (MIO), joint pain, joint noise, and disc position were the variables assessed by clinical examination and MRI before and 6 months after the surgery. ResultsThe sample consisted of 20 patients. In the postoperative evaluation, MIO had increased from 33.8 ± 4.83 mm to 35.1 ± 4.08 mm (p = 0.04), while joint pain had decreased from 7.5 ± 1.42 points to 2.05 ± 1.47 points (p = 0.001). With regard to joint noise, 19 of the patients had presented with clicking or crepitation but after 6 months these were completely absent. Disc repositioning was complete in 15 of the patients and partial in the other five. ConclusionThe technique of arthroscopic discopexy with anchors was shown to be effective in treating temporomandibular internal derangement, with good clinical results.

Functional changes of the lateral pterygoid muscle in patients with temporomandibular disorders: a pilot magnetic resonance images texture study.

Background:Texture features were the intrinsic properties of the human tissues and could efficiently detect the subtle functional changes of involved tissue. The pathologic changes of the lateral pterygoid muscle (LPM) were significantly correlated with the temporomandibular disc displacement. However, the occult functional changes of LPM could not be detected by the naked eye on the medical images. The current study was aimed to evaluate the functional changes of the LPM in the patients with temporomandibular disorders (TMDs) using texture analysis.Methods:Twenty-nine patients with TMD were performed with magnetic resonance (MR) imaging on a 3.0T MR scanner, who were consecutively recruited from the TMD clinic of Hainan Hospital of Chinese People's Liberation Army General Hospital from February 2019 to September 2019. The patients were classified into three groups according to the disc displacement: disc without displacement (DWoD), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The gray-level co-occurrence matrix method was applied with the texture analysis of LPM on the axial T2-weighted imaging. The texture features included angular second moment, contrast, correlation, inverse different moment, and entropy. One-way analysis of variance was used for grouped comparisons and receiver operating characteristics (ROC) curve analysis was applied to evaluate the diagnostic efficacy of the texture parameters.Results:Texture contrast of LPM presented significantly lower in DDWoR (46.30 [35.03, 94.48]) than that in DWoD (123.85 [105.06, 143.23]; test statistic = 23.05; P < 0.001). Texture entropy of LPM showed significant differences among DWoD (7.62 ± 0.33), DDWR (6.76 ± 0.35), and DDWoR (6.46 ± 0.39) (PDWoD-DDWR < 0.001, PDWoD-DDWoR < 0.001, and PDDWR-DDWoR = 0.014). Area under the ROC curve (AUC) demonstrated that texture entropy had an excellent diagnostic accuracy for DWoD-DDWR (AUC = 0.96) and DWoD-DDWoR (AUC = 0.98).Conclusion:The texture contrast and entropy could identify the altered functional status of LPM in patients with TMD and could be considered as the effective imaging biomarker to evaluate the functional changes of LPM in TMD.

Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents.

The aim of this cross-sectional research was to analyze the association between the disc position of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and the mandibular deviation evaluated by posteroanterior cephalometric (PA) in adolescents. The sample was 53 adolescents aged 11-18 years. This cross-sectional study was based on the analysis of PA and bilateral TMJ MRI images retrospectively selected. The mandibular deviation was evaluated by PA and defined by the amount of menton (Me) deviation from the midsagittal reference line. The temporomandibular disc position was evaluated by MRI: normal (N), disc displacement with reduction (DDR) and disc displacement without reduction (DDNR). The DDNR was considered more severe than the DDR. The patients were classified into three groups based on the bilateral disc position: group I, the same bilateral disc position; group II, disc displacement more severe on the ipsilateral side of the menton deviation; group III, disc displacement more severe on the contralateral side of the menton deviation. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between the menton deviation and the bilateral disc position. There was an association statistically significant between the bilateral disc position and the Me deviation (p<0.05). There were significant differences in the mean of the menton deviation between group II (4,40 ±2,26), and group I (2,17±1,93) and III (2,10±1,70). The menton deviation was significantly correlated with the disc position in the TMJ exhibit more deflection to the side more affected.

Evaluation of the compatibility of clinical primary diagnoses with mri reports in patients with temporomandibular disc displacement

Aim: Temporomandibular joint disorder (TMD) is a common disease group in the community that includes chewing muscles and temporomandibular joint (TMJ) components. TMJ diseases are also the main cause of non-odontogenic pain of the orofacial region. The aim of this study is to evaluate the consistency between clinical diagnosis and Magnetic Resonance Imaging (MRI) reports in patients with reduction with disc displacement (DDWR) and reduction without disc displacement (DDWoR). Materials and Methods: A total of 62 TMJ anamnesis records and MRI results were evaluated by authors. Radiology reports and anamnesis records were divided into two groups according to the clinical primary diagnosis file as DDWR and DDWoR. The clinical and radiographic results were compared each other and the correlation between these results was evaluated statistically. Results: The study includes sixty-two patients’ MRI reports and TMJ clinical anamnesis files (12 males and 50 female) with a mean age of 31.20±13.66 years. In group DDWoR there is only 41.9 % and in group DDWR there is only 45.2 % correlation found between clinical and MRI reports of the patients. Although the values obtained are statistically significant, there is insignificant agreement between in the TMJ clinical anamnesis file and MRI report results. There is no statistically significant difference between primary clinical diagnosis groups in terms of clinical and MRI diagnosis compatibility. Conclusion: It is concluded that clinical findings determined by the clinicians do not compatible MRI reports determined by radiologist. This may be due to the subjective nature of the clinical findings, and both MRI and clinical results are needed for precise results.

Effect of transcutaneous electrical nerve stimulation on jaw movement-evoked pain in patients with TMJ disc displacement without reduction and healthy controls

Objective: Transcutaneous electrical nerve stimulation (TENS) may serve as non-invasive intervention for painful temporomandibular disorders (TMD) to improve jaw motor function, but its efficacy is still debated. This parallel study evaluated the effect of TENS on pain and movement patterns after repeated jaw movements in patients with painful temporomandibular joints (TMJ) and disc displacement without reduction (DDwoR), and compared with healthy controls.Material and Methods: 20 patients with TMJ pain and DDwoR and 20 age- and gender-matched healthy volunteers were randomly assigned to TENS/sham TENS (sTENS) intervention groups in a block design (10 in each group). Participants performed 20 repeated jaw movements (4 x 5 sessions), and reported pain intensity on a 0–10 Numerical Rating Scale (NRS) subsequently both before and after the intervention. Data were tested by repeated measures analysis of variance (ANOVA).Results: Significant increase of pain intensity and reduction of opening range were shown within repeated jaw movements in TMJ pain patients in contrast to healthy participants (p ≤ .001). Pain was significantly reduced during repeated open-close (p = .007), fast open-close (p = .016) and horizontal movements (p = .023), accompanied with increased opening range (p = .033) and open-close velocity (p = .019) with TENS intervention when compared with sTENS group (p > .05) in TMJ pain patients.Conclusions: This study indicated that movement-evoked pain was reduced either spontaneously or by sTENS in TMJ pain patients with DDwoR, and interestingly, that TENS could attenuate movement-evoked pain and improve jaw motor function during repeated jaw movements. The findings may have implications for TENS treatment in TMJ pain patients with DDwoR.

Does Incidence of Temporomandibular Disc Displacement With and Without Reduction Show Similarity According to MRI Results?

The aim of this study is to assess MRI reports of the patients and to provide retrospective analysis by conducting detailed evaluation of temporomandibular disc position. MRI images of 259 patients from 2008 to 2017 were reviewed retrospectively. Existence of disc displacement in joint with and without reduction, existence of effusion in joint gap, arthritis, degenerative changes in joints and limitation of movement of joint and anatomic characteristics were evaluated. One hundred and seventeen (45.2%) of the patients had healthy joint connection bilaterally. Anterior disc displacement was observed in 101 (38.9%) of the patients. The number of the patients having disc displacement with reduction was 50 (19.3%) and without reduction was 51 (19.6%) similarly. The incidence of anterior disc displacement with or without reduction was similar; besides this, the majority of the patients diagnosed with anterior disc displacement were unilateral.

Shear Wave Elastography in the Evaluation of Temporomandibular Joint Disorders

We aimed at verifying the usefulness of shear wave elastography in determining the temporomandibular disc stiffness in patients with a temporomandibular disorders (TMDs). The study included 37 patients with confirmed TMDs and 208 healthy volunteers. Patients presented with significantly greater stiffness of the intermediate zone of the disc (region of interest [ROI] 1) and significantly lower stiffness of its anteriorly displaced portion (ROI 3). A receiver operating characteristics analysis indicated that a decrease in the stiffness in ROI 3 less than 8.667 KPa provided 100% sensitivity, 97.3% specificity, 100% positive predictive value (PPV) and 99.5% negative predictive value (NPV) in distinguishing between patients with TMDs and without. Whereas an increase in ROI 1 stiffness to at least 54.33 KPa provided high specificity and NPV, both the sensitivity and the PPV of this predictor equaled zero. Findings suggest that a decrease in anteriorly dislocated disc stiffness less than 8.667 kPa can accurately identify patients with TMDs.

MRI observation of condylar location and morphology in the patients with temporomandibular disc displacement

Objective: To evaluate the mandibular condylar location and morphology in the temporomandibular joint disorders. Methods: One hundred thirty-seven TMD patients (age 37.5±16.1 years, male/female=39/98) were performed with MRI scan for temporomandibular joint (TMJ) from November, 2011 to April, 2019 in Department of Radiology,Hainan Hospital of General Hospital of Chinese PLA and General Hospital of Chinese PLA. The patients were classified into 3 groups according the disc displacement: disc without displacement (DWoD) (185 TMJ), disc displacement with reduction (DDWR) (17 TMJ) and disc displacement without reduction (DDWoR) (72 TMJ). The location (anterior position, central position and posterior position) and morphology (oval shape, flat shape and beaklike shape) of the condylar head were observed on the sagittal PDWI, and the long and short axes were measured on the axial T2WI. Another groups were classified into 3 subgroups according to the disc displacement of bilateral TMJ: bilateral normal disc location (biND) (74 cases), unilateral disc displacement (uniDD) (40 cases) and bilateral disc displacement (23 cases). The inter-condyle angle was measured on the axial T2WI. Results: There was no significant difference for the location of condylar head among DWoD, DDWR and DDwoR groups (χ(2)=7.435, P=0.115). The rate for flat condylar shape was significantly higher in DWoD group [83.9%(115/137)] than that in DDWoR group [50.7%(34/67)], and the rate for beaklike condylar shape was significantly lower in DWoD group [16.1%(22/137)] than that in DDWoR group [49.3%(33/67)] (χ(2)=23.521, P<0.001). The length of long axis presented significantly longer in DWoD group [(17.2±2.4) mm] than that in DDWR group [(15.4±2.0) mm] and that in DDWoR group [(14.7±2.7) mm] (P<0.05). The length of short axis presented significantly longer in DWoD group [(7.3±1.2) mm] than that in DDWR group [(6.5±1.3) mm] and that in DDWoR group [(6.1±1.4) mm] (P<0.05). The inter-condyle angle presented significantly larger in biND group (136°±13°) and uniDD group (132°±14°) than that inbiDD group (124°±17°) (P<0.05). Conclusions: The mandibular condylar morphology changes significantly presented in the patients with temporomandibular disc displacement for the temporomandibular disorders.

Temporomandibular Joint Condyle–Disc Morphometric Sexual Dimorphisms Independent of Skull Scaling

Approximately 2 to 4% of the US population have been estimated to seek treatment for temporomandibular symptoms, predominately women. The study purpose was to determine whether sex-specific differences in temporomandibular morphometry result from scaling with sex differences in skull size and shape or intrinsic sex-specific differences. A total of 22 (11 male [aged 74.5±9.1years]; 11 female [aged 73.6±12.8years]) human cadaveric heads with no history of temporomandibular disc derangement underwent cone beam computed tomography and high-resolution magnetic resonance imaging scanning to determine 3-dimensional cephalometric parameters and temporomandibular morphometric outcomes. Regression models between morphometric outcomes and cephalometric parameters were developed, and intrinsic sex-specific differences in temporomandibular morphometry normalized by cephalometric parameters were determined. Subject-specific finite element (FE) models of the extreme male and extreme female conditions were developed to predict variations in articular disc stress-strain under the same joint loading. In some cases, sex differences in temporomandibular morphometric parameters could be explained by linear scaling with skull size and shape; however, scaling alone could not fully account for some differences between sexes, indicating intrinsic sex-specific differences. The intrinsic sex-specific differences in temporomandibular morphometry included an increased condylar medial length and mediolateral disc lengths in men and a longer anteroposterior disc length in women. Considering the extreme male and female temporomandibular morphometry observed in the present study, subject-specific FE models resulted in sex differences, with the extreme male joint having a broadly distributed stress field and peak stress of 5.28MPa. The extreme female joint had a concentrated stress field and peak stress of 7.37MPa. Intrinsic sex-specific differences independent of scaling with donor skull size were identified in temporomandibular morphometry. Understanding intrinsic sex-specific morphometric differences is critical to determining the temporomandibular biomechanics given the effect of anatomy on joint contact mechanics and stress-strain distributions and requires further study as one potential factor for the increased predisposition of women to temporomandibular disc derangement.

Comparison of the Short-Term Effectiveness of Hard and Soft Stabilizing Appliances in Treating Patients with Acute Temporomandibular Disc Displacement without Reduction

Comparison of the Short-Term Effectiveness of Hard and Soft Stabilizing Appliances in Treating Patients with Acute Temporomandibular Disc Displacement without Reduction

Ultrasonographic evaluation of masseter muscle thickness in patients with disk displacement with reduction.

This study was performed to ultrasonographically assess the masseter muscle thicknesses of individuals with disk displacement with reduction. The thickness of the masseter muscle in 100 patients (28 male, 72 female; average age 34years) who presented with one-sided temporomandibular joint pain and a clicking sound and were diagnosed with disk displacement with reduction was measured in relaxation and at maximum contraction using ultrasonography. In the contracted position, the difference in the masseter muscle thickness between the healthy side and the side with disk displacement with reduction was statistically significant (p < 0.05). However, no statistically significant difference was found between the two sides in the relaxed position. Obvious ultrasonographic changes of the masseter muscle were found in patients with temporomandibular disk displacement with reduction, and these changes might be related to unilateral chewing. Individuals with anterior disc displacement probably chew unilaterally because of pain and clicking.

Range and pattern of mandibular opening in patients with anterior displacement of temporomandibular disc without reduction

Range and pattern of mandibular opening in patients with anterior displacement of temporomandibular disc without reduction

Mandibular Condyle Reconstruction With Fibula Free-Tissue Transfer: The Role of the Masseter Muscle.

Free fibula flap is an option for primary restoration after disarticulation mandibular resection, though literature on technique refinements is scarce. The authors hypothesized that inset of the masseter, the key mandibular elevator muscle, at the reconstructed mandible may optimize functional recovery. All patients undergoing reconstruction of mandibulectomy-condylectomy defect (January 2009 to January 2014) by means of a fibular flap were prospectively studied. The neocondyle was formed by the distal portion of the fibula and placed directly into the glenoid fossa with preservation of the temporomandibular disc. The deep portion of the masseter was inset at the angle of the reconstructed mandible.Condylar position was postoperatively evaluated by panoramic radiographs. Patients self-evaluated speech, chewing, swallowing, and facial appearance. Two patients had immediate and 3 delayed reconstruction involving condyle ramus body, in the study period. During a mean follow-up of 32 months, 4 patients had satisfactory occlusion, 1 patient had an open-bite deformity, but was able to masticate solid food and maintain an oral diet. Although no significant condyle dislocation was recorded, 2 patients had slight ipsilateral deviation on mouth opening. Nevertheless, cosmesis was satisfactory and all patients maintained intelligible speech. Functional score was 13.6 ± 1.14 and facial appearance score was 4 ± 0.7. The free fibula transfers with direct seating of the fibula into the condylar fossa followed by masseter muscle reinsertion provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.

Outcomes and patient satisfaction following individualized physical therapy treatment for patients diagnosed with temporomandibular disc displacement without reduction with limited opening: A cross-sectional study

Objective: To investigate physical therapy treatment outcomes and patient satisfaction in patients with a diagnosis of disc displacement without reduction with limited opening (DDWoR wLO).Methods: Records of 97 patients with DDWoR wLO who received physical therapy in one outpatient clinic were used in this cross-sectional study. Outcomes included number of visits, maximum active interincisal opening, self-reported pain, and patient satisfaction.Results: The average number of physical therapy visits per patient was 5.5, and there were significant improvements in pain rating and interincisal opening following physical therapy. Effect sizes for these comparisons were large (>1.0). Mean patient satisfaction responses across all symptom areas was consistent with patients being more than less satisfied following treatment.Discussion: Individualized physical therapy treatment is an effective conservative intervention to improve mouth opening, reduce pain, and provide patient satisfaction in patients with one specific sub-type of temporomandibular disorder (TMD), DDWoR wLO.

Evaluation of orthognathic surgery on articular disc position and temporomandibular joint symptoms in skeletal class II patients: A Magnetic Resonance Imaging study.

BackgroundThe purpose of orthognathic surgery is to correct facial deformity and dental malocclusion and to obtain normal orofacial function. However, there are controversies of whether orthognathic surgery might have any negative influence on temporomandibular (TM) joint. The purpose of this study was to evaluate the influence of orthognathic surgery on articular disc position and temporomandibular joint symptoms of skeletal CI II patients by means of magnetic resonance imaging.Material and MethodsFor this purpose, fifteen patients with skeletal CI II malocclusion, aged 19-32 years (mean 23 years), 10 women and 5 men, from the Isfahan Department of Oral and Maxillofacial Surgery were studied. All received LeFort I and bilateral sagittal split osteotomy (BSSO) osteotomies and all patients received pre- and post-surgical orthodontic treatment. Magnetic resonance imaging was performed 1 day preoperatively and 3 month postoperatively. Descriptive statistics and Wilcoxon and Mc-Nemar tests were used for statistical analysis. P<0.05 was considered significant.ResultsDisc position ranged between 4.25 and 8.09 prior to surgery (mean=5.74±1.21). After surgery disc position range was 4.36 to 7.40 (mean=5.65±1.06). Statistical analysis proved that although TM disc tended to move anteriorly after BSSO surgery, this difference was not statistically significant (p value<0.05).ConclusionsThe findings of the present study revealed that orthognathic surgery does not alter the disc and condyle relationship. Therefore, it has minimal effects on intact and functional TM joint. Key words:Orthognathic surgery, skeletal class 2, magnetic resonance imaging, temporomandibular disc.