TMJ surgery following orthognathic surgery: A case series

Orthognathic surgery may affect or cause temporomandibular joint (TMJ) complaints. This study evaluated the need for TMJ surgery after orthognathic surgery. A retrospective cohort study was carried out on 630 consecutive patients undergoing at least a Le Fort I or bilateral sagittal split osteotomy (BSSO). The mean follow-up time was 2,3 years. Clinical, surgical and radiographic findings were collected. Ten of the 630 patients (1.6%) had additional arthroscopic TMJ-surgery in one (9) or in both (1) joints because of internal derangement, resistant to conventional therapy. Only 4/10 patients had successful outcomes following arthroscopic surgery. One patient with unsuccessful outcome required multiple additional open TMJ-surgeries, all remaining ineffective to relieve pain and restricted mouth opening. If arthroscopy failed to relieve symptoms (5/10 patients), further conservative management was opted. Arthroscopy seemed effective mainly in patients without pre-existing TMJ complaints. A further five of the 630 patients (0.8%) required more treatment because of bilateral postoperative condylar resorption, but none of them required TMJ-surgery. In contrast to patients with bilateral condylar resorption where the skeletal relapse remained the issue of concern, patients with internal derangement/osteoarthrosis exhibited major occlusal changes in one patient only (1/10), leaving the TMJ complaints as the main concern.