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Although orthognathic surgery has now become a routine part of oral and maxillofacial surgery practice, concern and apprehension about major jaw surgery continues to plague the minds of many orthodontists faced with the prospect of referring their patients for surgery. Like all surgery, complications also occur with orthognathic procedures, most of which can be prevented by thorough planning and careful surgery. In this article a brief overview of the potential complications associated with orthognathic surgery is presented for the benefit of orthodontists involved in the management of patients undergoing combined orthodontic-surgical treatment.

The aim of this narrative style review is to clarify the role of TMJ surgery in the management of specific TMJ disorders by introducing a simple and practical surgical classification. A decade ago, a new surgical classification was published which, like the Wilkes classification, included the five escalating degrees of joint pathology, but with more practical definitions and proposed surgical options for each of the disease categories. The classification begins with Category 1 - painful but otherwise structurally normal joints, which are largely managed nonsurgically. Categories 2 and 3 denote reducing and nonreducing disc displacement of the TMJ, respectively, with the former treated by TMJ arthrocentesis or level 1 arthroscopy and the latter best managed with disc repositioning or discopexy. Category 4 describes degenerative changes to the disc itself, where the disc cannot be salvaged and is thus removed with TMJ discectomy. Lastly, Category 5 refers to end-stage joint disease, where none of the joint components can be salvaged; both the disc and condylar head are sacrificed, and the TMJ is reconstructed with a prosthetic total joint replacement. In the decade since its publication, various studies have served to validate the usefulness of the TMJ surgical classification, and how it can be applied to better understand the role of TMJ surgery in everyday clinical practice., Competing Interests: Declaration of competing interest None., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to undertake a 5-year review of the OMX temporomandibular prosthetic total joint replacement system (OMX-TMJ)., Methods: Data was collected from patients who had an OMX-TMJ implanted between May 2015 and November 2020 at Epworth-Freemasons and St. Vincent's hospitals in Melbourne, Australia. The data points included patient demographics, primary diagnosis, and clinical outcomes in terms of visual analogue scale (VAS) for pain, maximum inter-incisal mouth opening, and complication events., Results: There were 206 OMX-TMJ devices implanted in 151 patients over the 5-year study period. The vast majority were female patients (n = 137, 90.7%) with a mean age of 44.8 years (range 20-76 years) at the time of surgery. Most patients presented with primary (idiopathic) osteoarthritis (119 joints-57.8%) that failed to respond to conservative measures. Based on a mean follow-up period of 36 months (range 12 months to 73 months), the average mouth opening improved from 30.8 mm pre-surgery to an average of 39.1 mm following OMX-TMJ surgery (p < 0.05). Joint pain (VAS: 0-10) significantly improved from 6.14 pre-surgery to 0.87 following OMX-TMJ surgery (p < 0.001). Twenty-one patients (13.9%) experienced device-related complications which resulted in explantation of 7 (3.4%) OMX-TMJ devices over the 5-year period., Conclusion: This study shows that the OMX-TMJ prosthetic total joint replacement system is a reasonably safe, versatile, and reliable implant that effectively improves mandibular opening and reduces joint pain across a broad range of end-stage TMJ disorders., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)