Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts® total joint prostheses: Part II – Airway changes and stability

The purpose of this study was to evaluate the anatomical changes and stability of the oropharyngeal airway and head posture following TMJ reconstruction and mandibular advancement with TMJ Concepts custom-made total joint prostheses and maxillary osteotomies with counter-clockwise rotation of the maxillo-mandibular complex. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford). The lateral cephalograms of 47 patients were analyzed to determine surgical and post-surgical changes of the oropharyngeal airway, hyoid bone and head posture. Surgery increased the narrowest retroglossal airway space 4.9 mm. Head posture showed flexure immediately after surgery (−5.6 ± 6.7°) and extension long-term post surgery (1.8 ± 6.7°); cervical curvature showed no significant change. Surgery increased the distances between the third cervical vertebrae and the menton 11.7 ± 9.1 mm and the third cervical vertebrae and hyoid 3.2 ± 3.9 mm, and remained stable. The distance from the hyoid to the mandibular plane decreased during surgery (−3.8 ± 5.8 mm) and after surgery (−2.5 ± 5.2 mm). Maxillo-mandibular advancement with counter-clockwise rotation and TMJ reconstruction with total joint prostheses produced immediate increase in oropharyngeal airway dimension, which was influenced by long-term changes in head posture but remained stable over the follow-up period.