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The presence of concomitant Temporomandibular Disorders (TMD) is considered a risk factor that can affect the outcomes of orthognathic surgery. Therefore, it is important for the surgeon to determine the severity and diagnosis of the TMD by clinical examination prior to surgery. Accurate diagnosis of TMD is a challenge as the diagnosis of TMD in patients with dentofacial deformities (DFD) can range from myalgia, arthralgia, articular disc disorders to degenerative joint disease. The objective of the study was to compare two clinical evaluation methods to accurately diagnose Temporomandibular Disorders in orthognathic surgery patients.
Materials and methods: In this observational study, sixty nine patients scheduled to undergo orthognathic surgery at an academic medical center by a single surgeon were clinically evaluated for temporomandibular disorders. The study subjects consisted of orthognathic surgery patients undergoing preoperative evaluation in an outpatient clinic 2-4 weeks prior to surgery. Inclusion criteria were: a) Patients above 14 years of age with DFD undergoing orthognathic surgery, b) Standardized preoperative clinical examination for TMD, and, c) Availability of complete records. Clinical TMJ examination was performed in each patient by two independent examiners, using distinct evaluation methods.
Method 1) Examination by an independent oral and maxillofacial surgeon who is not part of the clinical care of the patient. This method used validated symptom questionnaire and clinical examination form with an algorithm to arrive at a diagnosis as described by the Diagnostic Criteria for Temporomandibular disorders (DC/TMD).
Method 2) Examination by an experienced oral and maxillofacial surgeon who is the treating the patient, using a standard evaluation form.
Both examiners assigned the patients to one of two groups: TMD group or Non-TMD group. Data obtained from both types of clinical examination was further compared for differences in each individual diagnosis categorizing of TMDs- myalgia, arthralgia, articular disc disorders to degenerative joint disease.
Results: Of the total 69 patients enrolled in the study, 46 were females and 23 were males. Average age of patient was 24 years with a range of 14-45 years. There is overlap of different categories of TMD diagnosis as patients can have more than one diagnosis of the TMD. A summary of the differences observed between the two evaluations is shown below:
|
Method 1 DC/TMD protocol exam (n=69) |
Method 2 Routine TMJ exam (n=69) |
Myalgia, Arthralgia, TMD-related Pain and Headache |
22 |
42 |
Intra-articular disorder |
18 |
36 |
Degenerative Joint disorder |
10 |
0 |
No. patients assigned to TMD group |
33 |
41 |
No. patients assigned to Non-TMD group |
36 |
28 |
Conclusions:
Based on the results of comparison between two methods, we observed that an experienced surgeon categorized the orthognathic surgery patients in the TMD group more often than an independent surgeon using DC/TMD method. Both methods arrive at the diagnosis however, the DC/TMD method allowed the independent examiner to distinguish the different types of temporomandibular disorders myalgia, arthralgia, intra-articular and degenerative disorders accurately.
References:
Lindenmeyer, A., et al., Oral and maxillofacial surgery and chronic painful temporomandibular disorders--a systematic review. J Oral Maxillofac Surg, 2010. 68(11): p. 2755-64.
Schiffman, E., et al., Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache, 2014. 28(1): p. 6-27