The effect of TMJ disk repositioning by suturing through open incision on adolescent mandibular asymmetry with and without a functional orthodontic appliance.

OBJECTIVE: The objective of this study was to evaluate the effect of combined temporomandibular joint (TMJ) disk repositioning by suturing through open incision and orthodontic functional appliance (OFA) treatment for adolescents with mandibular asymmetry. STUDY DESIGN: Adolescent patients (12-20 years old) with mandibular asymmetry combined with unilateral TMJ disk displacement without reduction were treated with disk repositioning by suturing through open incision with and without postoperative OFA. Magnetic resonance imaging and posteroanterior cephalometric radiographs (PA) were used to measure and compare the changes in condylar height, joint space, and menton deviation pre- and postoperatively. RESULTS: Twenty-six patients were included in the study. Joint space was significantly increased postoperatively and new bone mostly formed at the superior or posterior superior part of the condyle after 6 to 18 months in all surgically treated joints. Fourteen patients with OFA had a significant increase in condylar height and menton deviation compared to 12 patients without OFA (2.29 +/- 0.91 mm vs 1.22 +/- 0.69 mm, P = .003; 4.56 +/- 1.48 mm vs 2.01 +/- 0.74 mm, P = .000). CONCLUSIONS: Combined treatment with TMJ disk repositioning by suturing through open incision and OFA can promote condylar growth and correct mandibular deviation in adolescent patients. Postoperative OFA can maintain the increased joint space created by disk repositioning and promote new bone formation at the superior and posterior parts of the condyle.