The preoperative condition of the temporomandibular joint and role of disc perforation in postoperative condylar resorption in Class II orthognathic surgery patients

K Takahashi; K Kamei; T Eda; Y Suzuki; M Tajima; T Hirano

doi:10.1016/j.ijom.2025.11.009

The preoperative condition of the temporomandibular joint and role of disc perforation in postoperative condylar resorption in Class II orthognathic surgery patients

Int J Oral Maxillofac Surg. 2025 Dec 10:S0901-5027(25)01504-8. doi: 10.1016/j.ijom.2025.11.009. Online ahead of print.

Authors

K Takahashi¹, K Kamei², T Eda³, Y Suzuki², M Tajima², T Hirano⁴

Affiliations

¹ Department of Dentistry and Oral Surgery, Yokohama Rosai Hospital, Yokohama, Japan. Electronic address: kosuke.takahashi.oms@gmail.com.
² Department of Dentistry and Oral Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
³ Department of Oral and Maxillofacial Radiology and Diagnosis, Tsurumi University School of Dental Medicine, Yokohama, Japan.
⁴ Hirano Orthodontic Clinic, Tokyo, Japan.

PMID: 41381270
DOI: 10.1016/j.ijom.2025.11.009

Abstract

This study was performed to investigate whether preoperative disc perforation is associated with postoperative condylar resorption (assessed as the 1-year change in mandibular ramus height) in skeletal Class II patients, and to analyse the preoperative temporomandibular joint (TMJ) morphology and synovial biomarkers in Class II and III patients. Orthognathic surgery patients treated between 2020 and 2022, who had undergone preoperative arthroscopy, MRI, CT, and synovial fluid analysis, were included. Three groups of patients were investigated: Class II with disc perforation (Class II/Pf(+); nine patients), Class II without disc perforation (Class II/Pf(-); eight patients), and Class III (seven patients). None of the Class III patients had disc perforation. Anterior disc displacement without reduction was significantly more common in Class II/Pf(+) than in Class II/Pf(-) (P = 0.033) and Class III (P = 0.017), suggesting that progressive disc displacement may lead to disc perforation. Moreover, TMJ osteoarthritis was significantly more frequent in Class II/Pf(+) than in Class II/Pf(-) (P = 0.037) and Class III (P = 0.005). Levels of IL-6 in the synovial fluid were significantly elevated in Class II/Pf(+) compared to Class III (P = 0.011), indicating an association between this inflammatory cytokine and the pathogenesis of TMJ deformities. Postoperative condylar resorption was significantly greater in Class II/Pf(+) (6.5%) than in Class II/Pf(-) (1.7%) (P = 0.019). These findings suggest that disc perforation in preoperative Class II patients is an important factor promoting postoperative condylar resorption. This study highlights the importance of preoperative evaluation of disc perforation in orthognathic surgery planning.

Keywords: Arthroscopy; Dentofacial deformities; MRI; Malocclusion; Temporomandibular joint.