Temporo mandibular joint (TMJ) pathologies in growing patients: Effects on facial growth and surgical treatment

Abstract

There are many temporomandibular joint (TMJ) conditions and pathologies that can be present at birth or develop during the growing years that can adversely affect facial growth and development. Some of these conditions can also cause pain, TMJ and jaw dysfunction, and disability. The mandibular condyles, an integral component of the TMJs, are a primary growth center of the mandible. The TMJs are the foundation and support for jaw position, TMJ and jaw function, occlusion, facial balance, normal facial growth and development, as well as comfort. In the presence of TMJ pathology that affects the condyles, growth may be significantly altered creating dentofacial deformities and treatment outcomes for corrective jaw surgery may be unsatisfactory relative to function, esthetics, occlusion, skeletal stability, and pain if the TMJ pathology is ignored. The most common TMJ disorders affecting growth and development can be divided into two basic categories: condylar hyperplasia (over-development) and condylar under-development or resorption. Predictability of results and limiting correction of the jaw and TMJ-related deformities to one major operation can usually best be achieved by waiting until facial growth is normally complete. Some required surgical procedures may have an adverse affect on subsequent facial growth. There are definite indications for early surgery such as ankylosis, growth center transplants (i.e., rib or sternoclavicular grafts), masticatory dysfunction, tumor removal, airway obstruction, sleep apnea, and psychosocial factors. TMJ and orthognathic surgery can be performed safely and predictably at the same operation. The surgical procedures can be separated into two or more surgical stages, but the TMJ surgery should be done first.