Modified condylotomy

Abstract

The original condylotomy procedure is a closed condylar neck osteotomy performed percutaneously with a Gigli saw without control of the occlusion. Modified condylotomy, a modification of the intraoral vertical ramus osteotomy (IVRO), was developed to provide greater surgical control and minimize surgical complications. The purpose of modified condylotomy is to achieve vertical condylar sag, thereby increasing joint apace with the goals of restoring normal disk position, obtaining prompt pain relief, restaging internal derangement, allowing for resolution and healing of arthritic lesions, and in some cases reversing degenerative joint disease/osteoarthrosis. The modified condylotomy is an extra-articular procedure and therefore there is no surgically-induced scarring of the bone, the disc, or the capsule of the joint. Essentially, it is a controlled condylar fracture. The net effect is indirect arthroplasty. Prospective 1- and 3-year outcome studies of both early and late-stage internal derangement and osteoarthrosis have shown the effectiveness of modified condylotomy for relief of pain and dysfunction. The procedure has the highest documented rate of disk reduction of any surgical procedure for early-stage disease (reducing disk displacement). Incipient condylar bone lesions have been aborted with formation of new bone during the healing process. Data also suggest that the rate of progression of internal derangement and osteoarthrosis is substantially slowed by this procedure. The reoperation rate of failed condylotomy is low and the outcomes generally are good, especially when compared with reoperation rates and outcomes for intra-articular procedures. Finally even when the modified condylotomy fails, the joint never seems to be worse than before operation, as can occur with intra-articular procedures.