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Temporomandibular Joint Condylar Changes Following Maxillomandibular Advancement and Articular Disc Repositioning

Institution:
1Department of Pediatric Dentistry, Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista, Araraquara, Brazil. Electronic address: joaogonc2002@yahoo.com.br.
2Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Baylor University Medical Center, Dallas, TX, USA.
3University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
4University of Michigan, Ann Arbor, MI, USA.
Publisher:
Elsevier Science
Publication Date:
Oct-2013
Journal:
J Oral Maxillofac Surg
Volume Number:
71
Issue Number:
10
Pages:
1759.e1-15
Citation:
J Oral Maxillofac Surg. 2013 Oct;71(10):1759.e1-15.
PubMed ID:
24040949
PMCID:
PMC4185300
Appears in Collections:
NA-MIC
Sponsors:
R01 DE024450/DE/NIDCR NIH HHS/United States
U54 EB005149/EB/NIBIB NIH HHS/United States
Generated Citation:
Goncalves J.R., Wolford L.M., Cassano D.S., da Porciuncula G., Paniagua B., Cevidanes L.H. Temporomandibular Joint Condylar Changes Following Maxillomandibular Advancement and Articular Disc Repositioning. J Oral Maxillofac Surg. 2013 Oct;71(10):1759.e1-15. PMID: 24040949. PMCID: PMC4185300.
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PURPOSE: To evaluate condylar changes 1 year after bimaxillary surgical advancement with or without articular disc repositioning using longitudinal quantitative measurements in 3-dimensional (3D) temporomandibular joint (TMJ) models. METHODS: Twenty-seven patients treated with maxillomandibular advancement (MMA) underwent cone-beam computed tomography before surgery, immediately after surgery, and at 1-year follow-up. All patients underwent magnetic resonance imaging before surgery to assess disc displacements. Ten patients without disc displacement received MMA only. Seventeen patients with articular disc displacement received MMA with simultaneous TMJ disc repositioning (MMA-Drep). Pre- and postsurgical 3D models were superimposed using a voxel-based registration on the cranial base. RESULTS: The location, direction, and magnitude of condylar changes were displayed and quantified by graphic semitransparent overlays and 3D color-coded surface distance maps. Rotational condylar displacements were similar in the 2 groups. Immediately after surgery, condylar translational displacements of at least 1.5 mm occurred in a posterior, superior, or mediolateral direction in patients treated with MMA, whereas patients treated with MMA-Drep presented more marked anterior, inferior, and mediolateral condylar displacements. One year after surgery, more than half the patients in the 2 groups presented condylar resorptive changes of at least 1.5 mm. Patients treated with MMA-Drep presented condylar bone apposition of at least 1.5 mm at the superior surface in 26.4%, the anterior surface in 23.4%, the posterior surface in 29.4%, the medial surface in 5.9%, or the lateral surface in 38.2%, whereas bone apposition was not observed in patients treated with MMA. CONCLUSIONS: One year after surgery, condylar resorptive changes greater than 1.5 mm were observed in the 2 groups. Articular disc repositioning facilitated bone apposition in localized condylar regions in patients treated with MMA-Drep.

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