Postsurgical Stability of Counterclockwise Maxillomandibular Advancement Surgery: Affect of Articular Disc Repositioning

Gonçalves, Joao Roberto; Cassano, Daniel Serra; Wolford, Larry M.; Santos-Pinto, Ary; Márquez, Iris Malagoni

doi:10.1016/j.joms.2007.11.007

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 4 , Pages 724-738, April 2008

Postsurgical Stability of Counterclockwise Maxillomandibular Advancement Surgery: Affect of Articular Disc Repositioning

Joao Roberto Gonçalves, DDS, PhD
- Assistant Professor of Orthodontics, Pediatric Dentistry Department, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil; formerly Fellow in Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, Baylor University Medical Center, Dallas, TX.
Daniel Serra Cassano, DDS
- Fellow in Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, Baylor University Medical Center, Dallas, TX.
Larry M. Wolford, DMD
- Clinical Professor, Department of Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University, and Private Practice, Baylor University Medical Center, Dallas, TX.
- Address correspondence and reprint requests to Dr Wolford: 3409 Worth St, Suite 400, Dallas, TX 75246
Ary Santos-Pinto, DDS, PhD
- Professor of Orthodontics, Pediatric Dentistry Department, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil.
Iris Malagoni Márquez, DDS, PhD
- Chairman, Department of Oral and Maxillofacial Surgery, Uberlandia Dental School, Uberlandia Federal University, Uberlandia, Brazil.

Purpose

This study evaluated the affect of disc displacement and articular disc repositioning on stability after surgical counterclockwise rotation and advancement of the maxillomandibular complex.

Patients and Methods

A total of 72 patients (59 females, 13 males), with an average age of 30 years (range, 15 to 60 years) were evaluated. The patients were divided into 3 groups. Group 1 (G1; n = 21), with healthy temporomandibular joints (TMJs), underwent double-jaw surgery only. Group 2 (G2; n = 35), with articular disc dislocation, underwent articular disc repositioning using the Mitek anchor (Mitek Surgical Products, Westwood, MA) technique concomitantly with orthognathic surgery. Group 3 (G3; n = 16), with articular disc dislocation, underwent orthognathic surgery only. Average postsurgical follow-up was 31 months. Each patient’s lateral cephalograms were traced, digitized twice, and averaged to estimate surgical changes and postsurgical stability.

Results

After surgery, the occlusal plane angle was decreased significantly in all 3 groups: by −6.3 ± 5.0° in G1, by −9.6 ± 4.8° in G2, and by −7.1 ± 4.8° in G3. The maxillomandibular complex was advanced and rotated counterclockwise similarly in all 3 groups, with advancement at the menton of 12.4 ± 5.5 mm in G1, 13.5 ± 4.3 mm in G2, and 13.6 ± 5.0 mm in G3; advancement at the B point of 9.5 ± 4.9 mm in G1, 10.2 ± 3.7 mm in G2, and 10.8 ± 3.7 mm in G3; and advancement at the lower incisor edge of 7.1 ± 4.6 mm in G1, 6.6 ± 3.2 mm in G2, and 7.9 ± 3.0 mm in G3. Postsurgery, the occlusal plane angle increased in G3 (2.6 ± 3.8°; 37% relapse rate) but remained stable in G1 and G2. Postsurgical mandibular changes in the horizontal direction demonstrated a significant relapse in G3 at the menton (−3.8 ± 4.1 mm; 28%), the B point (−3.0 ± 3.4 mm; 28%), and the lower incisor edge (−2.3 ± 2.1 mm; 34%) but remained stable in G1 and G2.

Conclusions

Maxillomandibular advancement with counterclockwise rotation of the occlusal plane is a stable procedure for patients with healthy TMJs and for patients undergoing simultaneous TMJ disc repositioning using the Mitek anchor technique. Those patients with preoperative TMJ articular disc displacement who underwent double-jaw surgery and no TMJ intervention experienced significant relapse.