ARTICLE Morphologic and Functional Changes in the Temporomandibular Joint and Stomatognathic System after Transmandibular Surgery in Oral and Oropharyngeal Cancers: Systematic Review Mohammed A.Q. Al-Saleh, BDS, MSc, MSc (TMD/OFP) Susan Armijo-Olivo, PhD, Norman Thie, DDS, MSc, MSc, Hadi Seikaly, MD, FRCSC, Pierre Boulanger, PhD, PEng, Johan Wolfaardt, BDS, MDent, PhD, and Paul Major, DDS, MSc, FRCD(C) ABSTRACT 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. SOMMAIRE Contexte: L’interruption de la continuite ´ mandibulaire dans la chirurgie transmandibulaire (mandibulotomie et mandibulectomie) pour l’exe ´ re ` se d’une tumeur sise dans la cavite ´ buccale ou dans l’oropharynx peut alte ´ rer la morphologie et le fonctionnement de la bouche et de l’articulation temporomandibulaire (ATM). Objectif: L’e ´ tude visait a ` re ´ aliser une analyse critique des donne ´ es disponibles en ce qui concerne les effets des ope ´ rations transmandibulaires sur les changements morphologiques et fonctionnels de l’ATM et du syste ` me stomatognathique. Sources de donne ´ es: Nous avons proce ´ de ´a ` une recherche e ´ lectronique dans les bases de donne ´ es Medline, Embase, Evidence- Based Medicine Reviews, Ovid HealthStar, et Scopus, ainsi qu’a ` un de ´ pouillement manuel. Journal of Otolaryngology-Head & Neck Surgery JOT_2012_120040.3d 28/9/12 20:48:13 The Charlesworth Group, Wakefield +44(0)1924 369598 - Rev 7.51n/W (Jan 20 2003) # 2012 The Canadian Society of Otolaryngology-Head & Neck Surgery DOI 10.2310/7070.2012.00039 Address reprint requests to: Mohammed A.Q. Al-Saleh, BDS, MSc, MSc (TMD/OFP) 5-549-476 Edmonton Health Academy, 11405-87 Avenue. Edmonton, AB T6G 1C9; e-mail: mo.alsaleh@gmail.com. Mohammed A.Q. Al-Saleh: Orthodontic Graduate Program, School of Dentistry; Susan Armijo-Olivo: Faculty of Medicine and Dentistry/Faculty of Rehabilitation Medicine; Norman Thie and Paul Major: School of Dentistry; Johan Wolfaardt: Department of Surgery, Faculty of Medicine and Dentistry; Pierre Boulanger: Department of Computing Science, University of Alberta, Edmonton, AB. Hadi Seikaly: Divisional Director and Zone Section Head Otolaryngology - Head and Neck Surgery, University of Alberta and Alberta Health Services, Edmonton, Alberta T6G 2B7; e-mail: hadi.seikaly@albertahealthservices.ca. 344 Journal of Otolaryngology-Head & Neck Surgery, Vol 41, No 5 (October), 2012: pp 344–359