Bilateral sagittal split osteotomy and temporomandibular disorders: rigid fixation versus wire fixation.

OBJECTIVE: 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. STUDY DESIGN: 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. RESULTS: There were no statistically significant differences in the CMI, MI, or DI change scores between the wire and rigid fixation groups (mean CMI(wire) = 0.05, mean CMI(rigid) = 0.04; mean DI(wire) = 0.02, mean DI(rigid) = 0. 01; mean MI(wire) = 0.08, mean MI(rigid) = 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. CONCLUSIONS: 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.

Effects of major Class II occlusal corrections on temporomandibular signs and symptoms.

This study explored the relationship between malocclusion and signs and symptoms of temporomandibular disorders (TMD) in 124 patients with severe Class II malocclusion, before and 2 years after bilateral sagittal split osteotomy (BSSO). Patients were evaluated with the Craniomandibular Index (CMI), the Peer Assessment Rating Index (PAR Index, to assess gross changes in the occlusion), and symptom questionnaires. The results showed a significant improvement in occlusion; PAR Index scores dropped from a mean of 18.1 before surgery to a mean of 6.1 at 2 years postsurgery (P < 0.001). The CMI and masticatory index (MI) for muscle pain indicated clinically small but statistically significant improvement (P = 0.0001) from before surgery (mean CMI = 0.14, mean MI = 0.15) to after surgery (mean CMI = 0.10, mean MI = 0.08). The number of patients with clicking upon opening decreased significantly from 33 (26.6%) to 13 (10.5%) (P = 0.001). However, the number of patients with fine crepitus increased from 5 (4.0%) before surgery to 16 (12.9%) at 2 years postsurgery (P = 0.005). Significant reductions in subjective pain and discomfort were also found 2 years after surgery. The magnitude of change in muscular pain was not related to the severity of the pretreatment malocclusion, a finding that suggests that factors other than malocclusion may be responsible for the change in TMD.

A no bleed implant.

Breast implants have evolved from the original saline-filled, smooth-surfaced silicone rubber bag to silicone gel-filled smooth-walled sacs to a combination of a silicone gel-filled bag within a saline-filled sac, and, most recently, a reversed, double-lumen implant with a saline bag inside of a gel-filled bag. Texture-surfaced implants were first used in 1970 when the standard silicone gel-filled implant was covered with a polyurethane foam. Because of concerns about the degradation products of this foam, they were removed from the market in 1991. In 1975 double-lumen silicone textured implants were developed, followed by silicone gel-filled textured implants. In 1990 a new radiolucent, biocompatible gel was produced that reduced the problem of radioopacity of silicone implants. Because of the gel's sufficiently low coefficient of friction, leakage caused by fold flaw fracture may also be decreased. We present a case where this new biocompatible gel implant was repositioned after four months. The resulting scar capsule in this soft breast was thin [< 0.002 cm (0.008 in.)] and evenly textured as a mirror image of the textured silicone surface. Scanning electron microscopy and x-ray defraction spectrophotometry revealed no silicone bleed.