Orthognathic Surgery as Treatment Choice for TMJ Disorder: A Case Report

Temporomandibular disorders (TMD) is a collective term used to describe a number of related disorders affecting the temporomandibular joints, masticatory muscles, and associated structures. The symptoms of temporomandibular joint disease manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. The symptoms are developing gradually and in early stages it may be asymptomatic. The etiology of TMD are complex and multifactorial. They are divided to Predisposing factors, Initiating factors, and Perpetuating factors. Treatment must be started based on the proper diagnosis, and almost all symptoms could be subsided by reversible options. But in dysgnathic patients more radical approach must be considered. A 20 years old male patient came with complaint of continuous mild pain and clicking sound on both of his TMJ when he was eating. The clicking on his TMJ has starts approximately 5 years ago and the pain develops approximately 2 years ago. From the cephalography imaging he has a class III malocclusion and was suggested orthognathic surgery to fix his occlusion as well as his complaint in his TMJ. He then undergo orthodontic treatment for a year as a preparation for orthognathic surgery. The changes of facial skeleton in TMD patients following orthognathic surgery have an impact on TMJ, masticatory musculature, surrounding soft tissues, and the changes of TMJ symptoms. Surgeons must keep in mind that any surgical procedures involving mandibular osteotomy can directly affect TMJ, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and orthognathic surgery.