Clinical Controversies in Oral and Maxillofacial Surgery: Part One

o e j c m hy consider performing temporomandibular joint TMJ) and orthognathic surgery at the same time hen a patient has coexisting TMJ pathology and a entofacial deformity? Isn’t that too aggressive? How ould the condylar position be controlled? Wouldn’t rthognathic surgery alone correct the TMJ probems? These are certainly suitable questions, but the uthor believes that appropriately trained and expeienced surgeons are able to more completely treat atients with improved effectiveness and outcome sing concomitant TMJ and orthognathic surgery. There are patients requiring orthognathic surgery or correction of dentofacial deformities who have oexisting TMJ pathology. In addition, there are paients with good skeletal and occlusal relationships ho have TMJ pathology, but when the TMJ patholgy is surgically corrected the occlusion may change ignificantly, creating a malocclusion. These patients an benefit from concomitant TMJ and orthognathic urgery, by a surgeon with surgical expertise in open MJ surgery and orthognathic surgery. Few surgeons urrently use this approach but instead ascribe to 1 of he following 4 philosophies when managing patients ith coexisting TMJ pathology and dentofacial deforities: 1) perform orthognathic surgery only to corect TMJ pathology; 2) perform TMJ treatment but gnore the dentofacial deformity; 3) ignore TMJ probems altogether; or 4) perform orthognathic surgery rst and then try to deal with the TMJ pathology later. he difficulty for many clinicians may lie in identifyng the presence of a TMJ condition, diagnosing the pecific TMJ pathology, and selecting the proper reatment for that condition. Further complicating the ituation is that some TMJ conditions may be relaively asymptomatic presurgery, increasing the diffi-