Head, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria.
Resident, Department of Oral and Maxillofacial Surgery, Academic Teaching Hospital, Feldkirch, Austria.
J Oral Maxillofac Surg. 2021 Apr;79(4):763-773. doi: 10.1016/j.joms.2020.11.010. Epub 2020 Nov 17.
The effects of orthognathic surgery (OGS) on the temporomandibular joint (TMJ) are still controversial. Based on a high-volume uniform collective, the function and clinical symptoms of the TMJ and the dysfunction index (Di) by Helkimo were evaluated prior and up to 2 years after OGS.
A longitudinal cohort study was performed between 2006 and 2016. A comprehensive examination focusing on TMJ function, temporomandibular disorder (TMD) symptoms, and the Di had been performed preopertaively (T0) and postoperatively at 6 weeks (T1), 6 months (T2), 1 year (T3), and 2 years (T4). The predictor variables used were sex, age, skeletal class, type of surgery, and amount of dysfunction or number of TMD complaints before treatment. The outcome of this study was TMD symptoms and the Di. Descriptive and bivariate statistics were computed, and the significance level was set at P < .05.
The sample consisted of 375 patients (247 women, 128 men, mean age 28.1 ± 9.4 years), 269 with skeletal Class II (71.7%) and 106 with skeletal Class III (28.3%) treated with sagittal split osteotomy bilateral sagittal split osteotomy (n = 173) or Le Fort I and bilateral sagittal split osteotomy (n = 202). Severe signs of dysfunction (Di 2/3) were seen in 5.9% of the patients before OGS and in 2.1% of the patients 2 years after OGS. The difference in Di (Di0/1 and Di2/3) between T0 and T1/T2 was statistically significant (P = .028; P = .011, respectively). TMD symptoms were significantly reduced 2 years after OGS (P = .028). Female gender (P = .013), skeletal Class II (P < .001), and counterclockwise rotation (P < .001) were the only risk factors significantly associated with the occurrence of TMD at T1.
The results of this study suggest that in most cases TMD symptoms can be significantly reduced and only a few can be induced with OGS. No risk factors were found for long-term effects on the TMJ.
正颌手术（OGS）对颞下颌关节（TMJ）的影响仍存在争议。基于大量统一的资料，本研究评估了 OGS 前后 2 年 TMJ 的功能、临床症状和 Helkimo 的功能障碍指数（Di）。
本研究为一项 2006 年至 2016 年期间的纵向队列研究。在术前（T0）、术后 6 周（T1）、6 个月（T2）、1 年（T3）和 2 年（T4），对 TMJ 功能、颞下颌紊乱（TMD）症状和 Di 进行了全面检查。术前的预测变量为性别、年龄、骨骼分类、手术类型以及治疗前的功能障碍程度或 TMD 症状数量。本研究的结果是 TMD 症状和 Di。采用描述性和双变量统计方法，显著性水平设为 P<.05。
该样本包括 375 名患者（247 名女性，128 名男性，平均年龄 28.1±9.4 岁），269 名骨骼分类为 II 类（71.7%），106 名骨骼分类为 III 类（28.3%），采用矢状劈开截骨术双侧矢状劈开截骨术（n=173）或 Le Fort I 和双侧矢状劈开截骨术（n=202）。术前严重功能障碍（Di 2/3）发生率为 5.9%，术后 2 年为 2.1%。T0 与 T1/T2 时 Di（Di0/1 和 Di2/3）差异具有统计学意义（P=.028；P=.011）。术后 2 年 TMD 症状明显减轻（P=.028）。女性（P=.013）、骨骼分类 II 类（P<.001）和逆时针旋转（P<.001）是 T1 时 TMD 发生的唯一危险因素。
本研究结果表明，OGS 可显著减轻大多数 TMD 症状，仅少数可诱发 TMD。未发现长期影响 TMJ 的危险因素。
