TMJ response to mandibular advancement surgery: An overview of risk factors

Obective: in order to understand the conficting information on temporomandibular joint (tmj) pathophysiologic responses after mandibular advancement surgery,an overview of the literature was proposed with a focus on certain risk factors. methods: a literature search was carried out in the cochrane,pubmed,scopus and web of science databases in the period from january 1980 through march 2013. various combinations of keywords related to tmj changes [disc displacement,arthralgia,condylar resorption (cr)] and aspects of surgical intervention (fxation technique,amount of advancement) were used. a hand search of these papers was also carried out to identify additional articles. results: a total of 148 articles were considered for this overview and,although methodological troubles were common,this review identifed relevant fndings which the practitioner can take into consideration during treatment planning: 1- surgery was unable to infuence tmj with preexisting displaced disc and crepitus; 2- clicking and arthralgia were not predictable after surgery,although there was greater likelihood of improvement rather than deterioration; 3- the amount of mandibular advancement and counterclockwise rotation,and the rigidity of the fxation technique seemed to infuence tmj position and health; 4- the risk of cr increased,especially in identifed high-risk cases. conclusions: young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful tmj,and are subject to less improvement after surgery and prone to cr. furthermore,thorough evidenced-based studies are required to understand the response of the tmj after mandibular advancement surgery.