Morphologic and functional changes in the temporomandibular joint and stomatognathic system after transmandibular surgery in oral and oropharyngeal cancers: systematic review.

BACKGROUND: Interruption of mandibular continuity in transmandibular (mandibulotomy and mandibulectomy) surgery for tumour resection in the oral cavity and oropharynx may alter oral and temporomandibular joint (TMJ) morphology and function.
OBJECTIVE: To critically analyze available evidence regarding the effects of transmandibular surgeries on morphologic and functional changes in the TMJ and stomatognathic system. DATA SOURCES: Electronic search of Medline, Embase, Evidence-Based Medicine Reviews, Ovid HealthStar, and Scopus and hand searches. INCLUSION CRITERIA: Any article investigating the TMJ morphologic changes and/or functional outcomes following transmandibular surgeries. RESULTS AND SYNTHESIS
METHODS: Two hundred seventy-one articles were obtained through the electronic database scan and six articles via a hand search. Twelve full articles were initially selected as potentially meeting the eligibility for this review; however, only five articles finally fulfilled the study inclusion criteria and were analyzed for their methodology. All articles used clinical records and/or patient reports to evaluate TMJ pain, motion, dental occlusion, mouth opening, and deflection during opening as outcome measures. In only four articles was a clinical examination conducted after surgery, with associated patients' interviews and reports. The quality of all included articles was considered poor with a high risk of bias according to the Research Triangle Institute item bank quality of assessment.
CONCLUSION: Based on the limited available evidence for this systematic review and a high risk of bias of the analyzed articles, no firm conclusions can be established regarding the effects of transmandibular surgery on morphologic and functional changes in the TMJ and stomatognathic system.