Search

This study compared outcomes of two surgical methods for patients diagnosed with active condylar hyperplasia type 1. Group 1 (n = 12) was treated with orthognathic surgery only, while group 2 (n = 42) was treated with high condylectomies, articular disc repositioning, and orthognathic surgery. There was no statistically significant difference between the two groups for maximum incisal opening, lateral excursions, and subjective jaw function before surgery. Group 2 showed more active presurgical mandibular growth (P < 0.05). At long-term follow up, no differences were found in lateral excursions and subjective jaw function. Group 2 showed a greater increase in maximum incisal opening (P < 0.01) and stability (P < 0.05) at long-term follow-up. All of the patients in group 1 grew back into skeletal and occlusal Class III relationships requiring secondary intervention, whereas all patients in group 2 remained stable in a Class I skeletal and occlusal relationship. Thus, patients with active condylar hyperplasia treated with high condylectomy, articular disc repositioning, and orthognathic surgery had stable, predictable outcomes compared with those treated with orthognathic surgery only. The high condylectomy effectively arrests disproportionate mandibular growth while maintaining normal jaw function.

The first 25 consecutive patients with high occlusal plane angulation, dysfunction, and pain who were treated with temporomandibular joint (TMJ) total joint prostheses and simultaneous maxillomandibular counterclockwise rotation were evaluated before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3) for surgical movements and long-term stability. Subjective ratings were used for patients’ facial pain/headache, TMJ pain, jaw function, diet, and disability, and objective functional changes were determined by measuring maximum incisal opening and lateral excursive movements. Results showed that the areas of greatest surgical change included an average decrease in the occlusal plane of 13.3 degrees with advancement at point B of 13.4 mm and at the genial tubercles of 16.3 mm. At longest follow-up, relapse was 0.7 degrees, 0.8 mm, and 1.2 mm, respectively, with no statistically significant changes. Significant subjective pain and dysfunction improvements were observed (P ≤ 0.001). Maximum incisal opening increased, but lateral excursion decreased. Those who had two or more previous TMJ surgeries showed greater levels of dysfunction at T1 and T3 than those who had one or no previous surgeries, but otherwise patients presented similar amounts of absolute changes. In conclusion, end-stage TMJ patients can achieve significant improvement in their pain, dysfunction, dentofacial deformity, and airway problems in one operation with TMJ reconstruction and mandibular advancement using TMJ custom-made total joint prostheses and simultaneous maxillary osteotomies for maxillomandibular counter-clockwise rotation.

Idiopathic condylar resorption (ICR) is a specific condition that affects the jaw joints (temporomandibular joints or TMJs) and most commonly occurs in teenage girls. It sometimes has been referred to as “cheerleaders syndrome,” because it frequently occurs in teenage girls participating in sports activities which, through minor or major trauma to the jaws, can initiate or exacerbate the condition. ICR is also known as idiopathic condylysis, condylar atrophy, and progressive condylar resorption. This is a well-documented but poorly understood disease process that occurs with a 9:1 female-to-male frequency ratio and rarely develops after the age of 20 years. A number of local and systemic pathologies or diseases can cause mandibular condylar resorption. Local factors include osteoarthritis, reactive arthritis, avascular necrosis, infection, and traumatic injuries. Systemic connective tissue or autoimmune diseases that can cause condylar resorption include rheumatoid arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, Sjogren syndrome, ankylosing spondylitis, and others. ICR is a specific disease entity different from these other disease processes. Therefore, it has a specific diagnostic presentation and treatment protocol. ICR causes mandibular condylar resorption and, with loss of vertical dimension of the condyle, it can create occlusal (bite relationship) and musculoskeletal instability, resulting in the development of dentofacial deformities, TMJ dysfunction, and pain. The occurrence of ICR has been identified by many authors as being associated with orthodontic treatment and orthognathic (i.e., corrective jaw) surgery (1–10). This association may, in fact, be coincidental and not reflect a specific cause-and-effect relationship. Recommended treatment for ICR at one time included splint therapy to minimize joint loading, nonloading orthodontic and orthognathic surgical procedures after the disease had been in remission 6 to 12 months, arthroscopic lysis and lavage, condylar replacement with a costochondral graft if the ICR could not be controlled or recurred, and maxillary surgery only to correct the occlusal deformity (5, 6, 11–14). None of these management strategies for ICR provides predictable, stable outcomes for the TMJ, optimizes function and aesthetic results, or eliminates pain. Wolford and Cardenas recently published a treatment protocol that effectively stops the disease process, provides reliable functional and aesthetic results, and eliminates or significantly reduces pain levels (15). This article presents the diagnostic factors for ICR, the specific treatment protocol, and the expected outcomes.

The temporomandibular joint (TMJ) is a bilateral diarthrodial joint of the jaws in the human skeleton. This unique joint can perform both hinge and sliding functions and is the only synovial joint in humans whose articulating surfaces are covered by fibrocartilage. The joint is formed by the bony articulations of the mandibular condyle and the temporal bone (glenoid fossa and articular eminence). Interposed between the condyle and the fossa is a piece of dense, avascular fibrous connective tissue, the TMJ articular disc. This disc divides the joint into superior and inferior joint compartments, which normally do not communicate with each other. The disc and condyle are in a normal anatomic relationship if the posterior band of the disc is located above the condylar head when the mandibular condyle is centrically positioned in the fossa (Figure 1a). The disc is attached to the condylar neck by ligamentous soft tissue attachments. The joint is circumferentially surrounded by a fibrous capsule and has