Temporomandibular joint condylar changes following maxillomandibular advancement and articular disc repositioning

J Oral Maxillofac Surg. 2013 Oct;71(10):1759.e1-15. doi: 10.1016/j.joms.2013.06.209.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arthritis / surgery
  • Bone Resorption / pathology
  • Cone-Beam Computed Tomography / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Imaging, Three-Dimensional / methods
  • Joint Dislocations / diagnosis
  • Joint Dislocations / surgery
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods
  • Male
  • Mandibular Advancement / methods*
  • Mandibular Condyle / pathology*
  • Maxilla / surgery*
  • Middle Aged
  • Models, Anatomic
  • Osteogenesis / physiology
  • Osteotomy, Le Fort / methods
  • Osteotomy, Sagittal Split Ramus / methods
  • Suture Anchors
  • Temporomandibular Joint / pathology*
  • Temporomandibular Joint Disc / pathology
  • Temporomandibular Joint Disc / surgery*
  • Temporomandibular Joint Disorders / surgery
  • Young Adult