Treating severe condylar resorption patients with orthognathic surgery and tumor necrosis factor alpha inhibitors

Objective: This study evaluates the longterm stability and efficacy of treating severe mandibular condylar resorption patients with orthognathic surgery and tumor necrosis factor alpha inhibitors (TNF-αI).

Methods: As part of an ongoing prospective study of orthognathic surgery patients with presurgical condylar resorption, we analyzed the results of those patients who received concomitant TNF-αI therapy as part of their treatment. We looked at the severity of their preoperative condition and the longterm stability of the mandibular condyles and occlusion post orthognathic surgery.

Results: We performed bimaxillary orthognathic surgery with counter-clockwise rotation on 7 patients with severe condylar resorption. Each patient was treated post operatively with a TNF-αI. The average advancement at pogonion was 19.3 mm. The average occlusal plane change was 15.9°. Mean follow up was 24 months (11–48). There was no statistical difference from immediate postsurgical overbite to the longterm overbite ( p = 0.31) and there were no frank openbites (minimum OB = 1.5 mm). Cone beam CT scans revealed only minor surface changes to the mandibular condyle post surgery. The average maximum incisal opening was 36.7 mm (32–47) before surgery and 41 mm after surgery (35–49). There were no complications as a result of taking TNF-αI (no infections, laboratory abnormalities, etc.).

Conclusions: It appears that in these seven patients concomitant TNF-αI therapy with orthognathic surgery is effective in preventing occlusal and skeletal relapse as a result of post surgical condylar remodeling.

Conflict of interest: None.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Treating severe condylar resorption patients with orthognathic surgery and tumor necrosis factor alpha inhibitors
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