Indication for intraoral vertical ramus osteotomy (IVRO): a follow-up report

Abstract

tomy and placement of costochondral grafts (n 14 sides) using endoscopic technique. The diagnoses were idiopathic condylar resorption (n 6), malunion of a fractured condyle (n 1), and degenerative joint disease (n 1). Inclusion criteria included condylar pathology requiring condylectomy and reconstruction; adequate preand postoperative documentation; and at least 6 months follow-up. Patients excluded had less than 6 months postoperative follow-up, and/or inadequate radiographs or clinical documentation. A 1.5-cm incision was made directly below the mandibular angle. The dissection was continued bluntly to the masseter muscle, which was incised using a needle point electrocautery. Then, with endoscopic elevators, an optical cavity was created for insertion of a Hopkins endoscope and visualization of the ramus/condyle unit (RCU). Anatomic landmarks were identified and the operation carried out with specially designed endoscopic equipment. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations, lateral cephalograms, and panoramic radiographs were used to evaluate the outcomes. Results: In all 8 cases condylectomy and CCG reconstruction (n 14 sides) was successfully performed using the endoscopic approach. The mean follow-up period was 17 months (range 8 to 38 months). Mean operating time was 52 minutes per side (range 25 to 75 minutes) and the average length of stay for all patients was 2 days (2 to 4 days). No intraoperative or long-term postoperative complications were encountered in any of the patients. One patient experienced transient marginal mandibular nerve weakness post-operatively that resolved within 2 weeks. Panoramic radiographs documented postoperative RCU position and lateral cephalograms documented mandibular position and closure of the anterior open bite. Measurements made from lateral cephalograms at T0 revealed that all 8 patients presented with a Class II malocclusion, mean RCU length was 4.6 cm, and mean openbite and overjet were 2.3 mm and 8 mm, respectively. At T1 all patients demonstrated Class I occlusion; a mean RCU length of 5.6 cm; overbite of 1.0 mm; and overjet of 2 mm. At T2 all patients maintained a Class I occlusion; mean RCU height was 5.4 cm; overbite was 1.8 mm; and overjet was 2.7 mm. Conclusion: The results of this case series indicate that endoscopic condylectomy and CCG is feasible with minimal morbidity and short-term stability comparable to standard techniques.