Publicação: Orthognathic surgery and temporomandibular disarrangement: a critical review of a complex relationship and two cases report
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CNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA::CIRURGIA BUCO-MAXILO-FACIAL
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Objective: The relationship between orthognathic surgery (OS) and temporomandibular disorders (TMD) remains one of the most complex and debated topics in oral and maxillofacial surgery. This critical review aims to synthesize current evidence regarding the bidirectional relationship between these entities: specifically, how surgical repositioning of the maxillomandibular complex modulates temporomandibular Joint (TMJ) function, and conversely, how the baseline structural integrity of the TMJ dictates the long-term stability of the surgical outcome. Findings indicate that patients with severe skeletal malocclusions exhibit a significantly higher prevalence of preoperative TMD signs and symptoms compared to normognathic controls. The literature concerning the effect of OS on TMD is conflicting; while most patients experience improvement or no change in TMD symptoms post-operatively, a subset experiences worsening symptoms or new-onset TMD. The response is highly variable and often depends on whether the underlying TMD is myogenic or arthrogenic. Crucially, pre-existing joint pathology, such as active condylar resorption or unstable internal derangement, significantly compromises the skeletal stability of OS outcomes, particularly in procedures involving bimaxillary advancement with counterclockwise rotation. Management strategies range from staged approaches, prioritizing joint stabilization before skeletal correction, to simultaneous combined TMJ and orthognathic procedures. Conclusion: OS should not be viewed reliably as a "cure" for TMD, though functional improvements often occur. Conversely, ignoring TMJ pathology can lead to disastrous surgical relapse. A comprehensive evaluation of the TMJ condition using advanced imaging prior to OS is mandatory to select the appropriate treatment sequence and manage patient expectations realistically.
Abstract
Palavras-chave
Orthognathic Surgery, Temporomandibular Joint Disorders, Dentofacial Deformity, Malocclusion, Joint Stability, Mandibular Condyle
Citação
SOUZA, Lívia Medeiros, et. al. Orthognathic surgery and temporomandibular disarrangement: a critical review of a complex relationship and two cases report. 2026. 22 f. Trabalho de Conclusão de Residência (Residência em Odontologia) - Universidade Federal de Uberlândia, Uberlândia, 2026.