Title Patients Undergoing Orthognathic Surgery Exhibiting No Presurgical Signs/Symptoms of TMD Pose a Risk of Developing TMJ Disorders Post Surgically
Clinical Question In patients undergoing orthognathic surgery who have no presurgical signs/symptoms of TMD, are they likely to develop TMD symptoms or to remain asymptomatic postsurgically?
Clinical Bottom Line Patients exhibiting no presurgical signs/symptoms of TMD pose a relative risk of developing TMJ disorders after orthognathic surgery. A 2009 systematic review found 13 studies with asymptomatic patients who developed new TMD signs/symptoms postsurgically, ranging from 4% to 35%. This is supported by two more recent retrospective studies that found patients who are asymptomatic before surgery pose a risk of developing TMD symptoms after orthognathic surgery.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19892270AI-Riyami/200913 studiesSystematic Review of case-control and cohort studies
Key resultsThe 13 studies evaluating patients who were asymptomatic before surgery demonstrated that 4% to 35% developed new signs/symptoms of TMD after the surgery.
21083902Dujoncquoy/201041 asymptomatic TMD patients undergoing orthognathic surgeryRetrospective Study
Key resultsThe 41 asymptomatic TMD patients evaluated in the study demonstrated that 24.4% developed pain, 42.9% sounds, 8.3% tenseness, 25% clicking, 17.4% joint locking, and 12.5% limited mouth opening postsurgically.
23426542Iannetti/20132,318 patients with no TMJ symptoms before surgery Retrospective Study
Key resultsTMD symptoms/signs developed postsurgically in 259 of the 2,318 patients (11.17%) who presented with no TMJ symptoms before surgery.
Evidence Search (TMD[All Fields] AND ("orthognathic surgery"[MeSH Terms] OR ("orthognathic"[All Fields] AND "surgery"[All Fields]) OR "orthognathic surgery"[All Fields])) AND ("2009/06/28"[PDat] : "2014/06/26"[PDat])
Comments on
The Evidence
Validity: The 2009 systematic review attempted to develop a quality-assessment scale to reduce bias and guide research; however, the results were predominantly narrative, resulting in subjective rather than statistical methods. The 2010 retrospective study evaluated its patients through a survey before and after the orthognathic surgery; thus, the evidence is based on the patient’s subjective diagnosis. While the 2013 retrospective study evaluated the patients clinically and radiographically, the authors believe that because of their sample size and heterogeneity of the group they were not able to significantly evaluate the real effects of orthognathic surgery on TMD. Nonetheless, the three articles provided relevant and beneficial information in answering the question. Perspective: The studies are difficult to compare and contrast due to the heterogeneity of the methods within the study. To obtain reliable scientific evidence, a homogenous group of patients undergoing the same procedure with a validated TMD diagnosis is needed to accurately determine the risk associated with asymptomatic TMD patients undergoing specific orthognathic surgical procedures.
Applicability It is critical to ensure that patients are adequately prepared for the orthognathic surgery, the postoperative recovery, and the outcome. The importance of this cannot be overstated because patients who believe they were given insufficient information tended to be more dissatisfied with the treatment results and TMD symptoms than those who believed they were properly informed. However, the studies did not report patients describing TMD symptoms that adversely affected the quality of their life. Nonetheless, the clinician and patient should be aware of any possible risks associated with the procedure.
Specialty (General Dentistry) (Oral Surgery) (Orthodontics)
Keywords temporomandibular joint, orthognathic surgery
ID# 2743
Date of submission 06/27/2014
E-mail tibbitts@livemail.uthscsa.edu
Author Luke Tibbitts
Co-author(s) Adel Alqarni and Mohammad Aljameel
Co-author(s) e-mail adel.qarni@hotmail.com, mhd-aljameel@hotmail.com
Faculty mentor Edward Ellis, III, DDS
Faculty mentor e-mail ellise3@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available