Temporomandibular joint disorders and maxillomandibular malformations: role of condylar "repositionin" plate. 2009

Noemi Mazzone, and Claudio Matteini, and Veronica Incisivo, and Evaristo Belli, and Belli Evaristo
Sant'Andrea Hospital, II Faculty of Medicine, University of Rome, La Sapienza, Italy.

Even if the relationship between condylar position and/or temporomandibular disorders (TMDs) and dentofacial deformity is controversial in literature, several patients presenting malocclusion refer to pain and TMDs as the main trouble. There are also various opinions concerning the alterations or improvements of temporomandibular joint symptoms after orthognathic surgery. In agreement with the experience of Universität Würzburg, the purpose of this study was to evaluate the validity of splint technique to reproduce centric condyle positioning in bimaxillary osteotomy surgeries for the patients with skeletal-facial disorders and coexisting TMDs. The present study is based on a sample of patients with maxillomandibular malocclusion and coexisting TMDs who underwent bimaxillary osteotomy surgeries with splint technique. All patients underwent a protocol consisting of various steps: Pretreatment evaluation consisted of a questionnaire on subjective symptoms, clinical examinations, photographs of the occlusion, plaster casts, bite registrations, examination of the posture; instrumental examinations; panoramic, teleradiography, and cephalometric analysis; stratigraphy of TMD; and electromyography. Presurgical treatment consisted of therapy by modified Farrar splint associated with a pharmacologic therapy for the acute symptoms; orthodontic treatment associated with a global reeducation of the posture and a pompage of the masticatory muscles; and manufacturing of an occlusal splint in the most posterior asymptomatic position. Surgical treatment consisted of bimaxillary osteotomies performed after registering condyle position by a "repositioning" plate. The condyle position is guided by the intermaxillary fixation with the interposition of the occlusal splint. Surgery on maxillary is performed through Le Fort I osteotomy and fixation. Later, sagittal splint osteotomy of mandible is performed. Position of ramus and TMD complex is guided by the positioning of the plates modeled previously and fixed to maxillary and ramus in the same relationship registered with the splint. Finally, fixation of mandibular osteotomies is performed. Postsurgically patients underwent orthodontic treatment (to stabilize occlusal and articular changes) and physical therapy. After the end of treatment, stability of results was investigated with clinical, radiologic, and electromyographic valuations. The authors' experience suggests that, as in orthognathic surgery, identification of a correct condyle-fossa relationship (achieved by splint and repositioning plate) is essential to guide osteosynthesis after sagittal split osteotomy in patients affected by TMDs and ultimately affects the stability of the procedure.

UI MeSH Term Description Entries
D007569 Jaw Abnormalities Congenital absence of or defects in structures of the jaw. Abnormalities, Jaw,Abnormality, Jaw,Jaw Abnormality
D007574 Jaw Relation Record A registration of any positional relationship of the mandible in reference to the maxillae. These records may be any of the many vertical, horizontal, or orientation relations. (Jablonski, Illustrated Dictionary of Dentistry) Axiography,Bite Registration,Sirognathography,Record, Jaw Relation,Records, Jaw Relation,Bite Registrations,Jaw Relation Records,Registration, Bite,Registrations, Bite
D008297 Male Males
D008310 Malocclusion Such malposition and contact of the maxillary and mandibular teeth as to interfere with the highest efficiency during the excursive movements of the jaw that are essential for mastication. (Jablonski, Illustrated Dictionary of Dentistry, 1982) Angle's Classification,Crossbite,Tooth Crowding,Cross Bite,Angle Classification,Angles Classification,Bite, Cross,Bites, Cross,Classification, Angle's,Cross Bites,Crossbites,Crowding, Tooth,Crowdings, Tooth,Malocclusions
D008335 Mandibular Condyle The posterior process on the ramus of the mandible composed of two parts: a superior part, the articular portion, and an inferior part, the condylar neck. Condyle, Mandibular,Condyles, Mandibular,Mandibular Condyles
D008410 Masticatory Muscles Muscles arising in the zygomatic arch that close the jaw. Their nerve supply is masseteric from the mandibular division of the trigeminal nerve. (From Stedman, 25th ed) Masticatory Muscle,Muscle, Masticatory,Muscles, Masticatory
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009971 Orthodontics, Corrective The phase of orthodontics concerned with the correction of malocclusion with proper appliances and prevention of its sequelae (Jablonski's Illus. Dictionary of Dentistry). Corrective Orthodontics
D009984 Orthopedic Fixation Devices Devices which are used in the treatment of orthopedic injuries and diseases. Device, Orthopedic Fixation,Devices, Orthopedic Fixation,Fixation Device, Orthopedic,Fixation Devices, Orthopedic,Orthopedic Fixation Device
D010027 Osteotomy The surgical cutting of a bone. (Dorland, 28th ed) Osteotomies

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