Bilateral sagittal split osteotomy and temporomandibular disorders: Rigid fixation versus wire fixation

• Published in: Oral surgery, oral medicine, oral pathology, oral radiology and endodontics Vol. 89; no. 1; pp. 29 - 34
• Main Authors: Nemeth, Dora Z., Rodrigues-Garcia, Renata C.M., Sakai, Shiro, Hatch, John P., Van Sickels, Joseph E., Bays, Robert A., Clark, Gary M., Rugh, John D.
• Format: Journal Article
• Language: English
• Published: St. Louis, MO Mosby, Inc 01-01-2000; Elsevier
• Subjects: Adult; Biological and medical sciences; Bone Wires - adverse effects; Bone Wires - statistics & numerical data; Dentistry; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Follow-Up Studies; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Jaw Fixation Techniques - adverse effects; Jaw Fixation Techniques - statistics & numerical data; Male; Maxillofacial surgery. Dental surgery. Orthodontics; Medical sciences; Non tumoral diseases; Osteotomy - adverse effects; Osteotomy - methods; Osteotomy - statistics & numerical data; Otorhinolaryngology. Stomatology; Postoperative Complications - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Temporomandibular Joint Disorders - etiology; Time Factors; Treatment Outcome; Human; Stomatology; Osteotomy; Diseases of the osteoarticular system; Temporomandibular joint; Bilateral; Wire; Result; Fixation; Functional recovery; Treatment; Dysfunction; Surgery; Technique; Sagittal slice; Comparative study; Maxillary disease; Rigid
• ISSN: 1079-2104; 1528-395X
• DOI: 10.1016/S1079-2104(00)80010-4

The effects of orthognathic surgery on temporomandibular disorders may be related to the surgical method that is used. Specifically, it has been suggested that the choice of stabilization technique may play a major role in the functional outcome of mandibular advancement surgery. The purpose of this study was to prospectively compare long-term (2 years) signs and symptoms of temporomandibular disorders after orthognathic surgery with bilateral sagittal split osteotomy in 127 patients randomized to receive rigid or wire fixation.
Signs and symptoms of temporomandibular disorders were evaluated before and 2 years after surgery by means of the overall craniomandibular index (CMI), dysfunction index (DI), and muscle index (MI). Patients also reported subjective symptoms of temporomandibular disorders by marking areas of pain on a standard drawing of the head and rating the pain in each area on a scale ranging from 1 (very mild) to 7 (very extreme). Subjective pain was also assessed through use of the Oral Health Status Questionnaire and by a rating of the difficulty in opening the mouth because of pain.
There were no statistically significant differences in the CMI, MI, or DI change scores between the wire and rigid fixation groups (mean CMlwire 0.05, mean CMrigid = 0.04; mean DIrigid 0.02, mean Dlrigid = 0.01; mean Mlwire=0.08, mean MIigid = 0.08) 2 years after surgery. Temporomandibular joint sounds also demonstrated no significant differences between the two fixation methods. Subjective pain reports were consistent with the clinical examinations. On average, both wire and rigid scores decreased slightly, but the change scores were not significantly different between groups.
These findings suggest that the long-term (2 years) effects of wire and rigid internal fixation methods on the signs and symptoms of temporomandibular disorders do not differ. Earlier concerns about increased risk for temporomandibular disorders with rigid fixation were not supported by these results.