Modified Condylotomy for Temporomandibular Joint Dysfunction

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Technique

The basic set of instruments required to perform a modified condylotomy includes wire twisters and wire cutters for arch-bar application; electrocautery for incision and hemostasis; a Molt periosteal elevator (No. 9) and Freer periosteal elevator for the lateral ramus and posterior border, respectively; a J-stripper for the lower border; a Woodson periosteal elevator to identify the sigmoid notch; a dental mirror to visualize the osteotomy site; a small curved osteotome and mallet to complete

Postoperative care

Maxillomandibular fixation (MMF) should be maintained for 3 weeks for unilateral procedures and 4 weeks for bilateral procedures. Periods of fixation as short as 10 days have been described but are not recommended. Transition to bilateral single light class II elastics should then be made for a period of 4 weeks, which typically results in a stable occlusion in most patients. The use of more elastics and an extended duration of elastic MMF should be considered when malocclusion is noted.

Outcomes

The majority of patients treated with a modified condylotomy report a reduction in pain and an improvement in function that seems to be independent of Wilkes classification (Fig. 8, Fig. 9, Fig. 10). Normalization of the disc/condyle relationship postoperatively appears to occur most frequently in Wilkes I, II, and III (early) internal derangements, whereas an improvement in the disc/condyle relationship is often all that can be achieved with Wilkes III (late), IV, and V internal derangements.

Complications

Condylar subluxation and medial displacement of the proximal segment are exceedingly uncommon with the modified condylotomy, but require immediate reoperation to reposition the proximal segment. Wire fixation to maintain the proximal segment in the correct position may on rare occasions be needed, and can be achieved by passing a 26-gauge wire through a small hole drilled in the distal aspect of the proximal segment and securing this to a monocortical screw placed in the distal segment near the

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