Advertisement

Planning for Combined TMJ Arthroplasty and Orthognathic Surgery

  • Larry M. Wolford
    Correspondence
    Corresponding author. 3409 Worth Street, Suite 400, Dallas, TX 75246.
    Affiliations
    Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX, USA

    Private Practice at Baylor University Medical Center, Dallas, TX, USA
    Search for articles by this author
  • Amit Dhameja
    Affiliations
    Department of Oral and Maxillofacial Surgery, Texas A&M University Health Science Center, Baylor College of Dentistry, Dallas, TX, USA

    Private Practice, Denton, TX, USA
    Search for articles by this author
      Temporomandibular joint (TMJ) and dentofacial deformities commonly coexist. The TMJ disorders may be the causative factor of the jaw deformity or may have developed as a result of the jaw deformity, or the 2 entities may occur independently of each other. The TMJs form the foundation for jaw position, function, occlusion, facial balance, and comfort. If the TMJs are not stable and healthy (nonpathologic), patients requiring orthognathic surgery may have unsatisfactory outcomes relative to function, aesthetics, occlusal and skeletal stability, and pain. The most common TMJ disorders that can adversely affect orthognathic treatment outcomes include (1) articular disc dislocation, (2) adolescent internal condylar resorption (AICR), (3) reactive arthritis, (4) condylar hyperplasia, (5) ankylosis, (6) congenital deformation or absence of the TMJ, (7) connective tissue and autoimmune diseases, and (8) other end-stage TMJ disorders. These TMJ conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, and sleep apnea. Patients with these conditions may benefit from corrective surgical intervention, including TMJ and orthognathic surgery. The difficulty for many clinicians is in identifying the presence of a TMJ condition, diagnosing the specific TMJ disorder, and selecting the proper treatment of that condition.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Further readings

        • Coleta K.E.
        • Wolford L.M.
        • Gonçalves J.R.
        • et al.
        Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part I–skeletal and dental stability.
        Int J Oral Maxillofac Surg. 2009; 38: 126-138
        • Coleta K.E.
        • Wolford L.M.
        • Gonçalves J.R.
        • et al.
        Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part II–airway changes and stability.
        Int J Oral Maxillofac Surg. 2009; 38: 228-235
        • Goncalves J.R.
        • Cassano D.S.
        • Wolford L.M.
        • et al.
        Postsurgical stability of counterclockwise maxillomandibular advancement surgery: affect of articular disc repositioning.
        J Oral Maxillofac Surg. 2008; 66 (article 52949): 724-738
        • Henry C.H.
        • Hughes C.V.
        • Gerard H.C.
        • et al.
        Reactive arthritis: preliminary microbiologic analysis of the human temporomandibular joint.
        J Oral Maxillofac Surg. 2000; 58: 1137-1142
        • Henry C.H.
        • Pitta M.C.
        • Wolford L.M.
        Frequency of chlamydial antibodies in patients with internal derangement of the temporomandibular joint.
        Oral Surg Oral Med Oral Pathol Orol Radiol Endod. 2001; 91: 287-292
        • Mehra P.
        • Wolford L.M.
        The Mitek mini anchor for TMJ disc repositioning: surgical technique and results.
        Int J Oral Maxillofac Surg. 2001; 30: 497-503
        • Mercuri L.G.
        • Wolford L.M.
        • Sanders B.
        • et al.
        Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system.
        J Oral Maxillofac Surg. 2002; 60: 1440-1448
        • Mehra P.
        • Wolford L.M.
        • Baran S.
        • et al.
        Single-stage comprehensive surgical treatment of the rheumatoid arthritis temporomandibular joint patient.
        J Oral Maxillofac Surg. 2009; 67: 1859-1872
        • Pinto L.P.
        • Wolford L.M.
        • Buschang P.H.
        • et al.
        Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part III–pain and dysfunction outcomes.
        Int J Oral Maxillofac Surg. 2009; 38: 326-331
        • Wolford L.M.
        • Cardenas L.
        Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes.
        Am J Orthod Dentofacial Orthop. 1999; 116: 667-676
        • Wolford L.M.
        • Cassano D.S.
        Autologous fat grafts around temporomandibular joint (TMJ) total joint prostheses to prevent heterotopic bone.
        in: Shiffman M.A. Autologous fat transfer. Springer-Verlag, Berlin2010: 361-382
        • Wolford L.M.
        • Cassano D.S.
        • Goncalves J.R.
        Common TMJ disorders: orthodontic and surgical management.
        in: McNamara J.A. Kapila S.D. Temporomandibular disorders and orofacial pain: separating controversy from consensus. vol. 46. Craniofacial Growth Series. The University of Michigan, Ann Arbor (MI)2009: 159-198
        • Wolford L.M.
        • Cottrell D.A.
        • Henry C.H.
        Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis.
        J Oral Maxillofac Surg. 1994; 52: 2-10
        • Wolford L.M.
        Facial asymmetry: diagnosis and treatment considerations.
        (Chapter 13)in: Fonseca R.J. Marciani R.D. Turvey T.A. 2nd edition. Oral and maxillofacial surgery. vol. 3. Saunders Elsevier, St Louis (MO)2008: 272-315
        • Wolford L.M.
        Idiopathic condylar resorption of the temporomandibular joint in teenage girls (cheerleaders syndrome).
        Proc (Bayl Univ Med Cent). 2001; 14: 246-252
        • Wolford L.M.
        • Karras S.C.
        Autologous fat transplantation around temporomandibular joint total joint prostheses: preliminary treatment outcomes.
        J Oral Maxillofac Surg. 1997; 55: 245-251
        • Wolford L.M.
        • Karras S.C.
        • Mehra P.
        Concomitant temporomandibular joint and orthognathic surgery: a preliminary report.
        J Oral Maxillofac Surg. 2002; 60: 356-362
        • Wolford L.M.
        • Karras S.C.
        • Mehra P.
        Considerations for orthognathic surgery during growth, part 1: mandibular deformities.
        Am J Orthod Dentofacial Orthop. 2001; 119: 95-101
        • Wolford L.M.
        • Karras S.C.
        • Mehra P.
        Considerations for orthognathic surgery during growth, part 2: maxillary deformities.
        Am J Orthod Dentofacial Orthop. 2001; 119: 102-105
        • Wolford L.M.
        • Mehra P.
        • Franco P.
        Use of conservative condylectomy for treatment of osteochondroma of the mandibular condyle.
        J Oral Maxillofac Surg. 2002; 60: 262-263
        • Wolford L.M.
        • Mehra P.
        • Reiche-Fischel O.
        • et al.
        Efficacy of high condylectomy for management of condylar hyperplasia.
        Am J Orthod Dentofacial Orthop. 2002; 121: 136-151
        • Wolford L.M.
        • Morales-Ryan C.A.
        • García-Morales P.
        • et al.
        Surgical management of mandibular condylar hyperplasia type 1.
        Proc (Bayl Univ Med Cent). 2009; 22: 321-329
        • Wolford L.M.
        • Pitta M.C.
        • Reiche-Fischel
        • et al.
        TMJ concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow-up.
        Int J Oral Maxillofac Surg. 2003; 32: 268-274
        • Wolford L.M.
        • Reiche-Fischel O.
        • Mehra P.
        Changes in TMJ dysfunction after orthognathic surgery.
        J Oral Maxillofac Surg. 2003; 61: 655-660
        • Wolford L.M.
        Surgical planning in orthognathic surgery.
        in: Booth P.W. Schendel S.A. Hausamen J.E. Maxillofacial surgery. vol. 2. Churchill Livingstone, St Louis (MO)2007: 1155-1210