Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses

Am J Orthod Dentofacial Orthop. 2009 Nov;136(5):626.e1-16, discussion 626-7. doi: 10.1016/j.ajodo.2009.02.022.


Introduction: There have been conflicting viewpoints in the literature regarding the effects of orthognathic treatment on temporomandibular disorders (TMD). A systematic review was conducted to determine the percentage of orthognathic patients with TMD, establish the range of signs and symptoms, and follow patients longitudinally through treatment for any changes in signs and symptoms.

Methods: Part 1 of this 2-part article described the methodology of this review, with a narrative analysis of the study characteristics and the TMD classification methods. Part 2 describes the percentage of patients suffering from TMD and the signs and symptoms reported. Meta-analyses were conducted on data from clinically similar studies.

Results: Pain decreased after surgery for both self-reported symptoms and clinically diagnosed pain on palpation. However, postsurgical results were more varied for joint sounds. The percentage of patients with clicking had a tendency to decrease postsurgery, but improvements in crepitus were questionable. The results from all meta-analyses in this review were subject to considerable statistical heterogeneity, and it was not possible to draw strong inferences relating to the percentage of orthognathic surgery patients with TMD with any degree of certainty.

Conclusions: Although orthognathic surgery should not be advocated solely for treating TMD, patients having orthognathic treatment for correction of their dentofacial deformities and who are also suffering from TMD appear more likely to see improvement in their signs and symptoms than deterioration.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Combined Modality Therapy
  • Humans
  • Malocclusion / etiology
  • Malocclusion / therapy
  • Maxillofacial Abnormalities / complications
  • Maxillofacial Abnormalities / therapy*
  • Oral Surgical Procedures / methods*
  • Orthodontics / standards*
  • Outcome Assessment, Health Care
  • Quality Assurance, Health Care
  • Temporomandibular Joint Disorders / classification
  • Temporomandibular Joint Disorders / diagnosis
  • Temporomandibular Joint Disorders / etiology
  • Temporomandibular Joint Disorders / therapy*