Prospective study of modified condylotomy for treatment of nonreducing disk displacement

Abstract

This study was performed to provide an objective assessment of the outcome of modified condylotomy for treatment of the painful temporomandibular joint with nonreducing disk displacement (Wilkes late stage III, IV, V). A prospective study of 31 consecutive patients (43 joints) was conducted. All patients had nonreducing disk displacement verified by means of disk imaging. Independent evaluations were performed to assess pain, dysfunction, and progression of disease. The examinations were performed before modified condylotomy and at intervals up to 1 year after the operation. Eighteen patients (26 joints) completed the required examinations. Patient-based assessments were completed for pain and diet on 15 of these 18 patients (23 joints) 3 years after the operation. Visual analog scale (VAS) scores (mean +/- SE) for pain improved from 7.4 +/- 0.4 before modified condylotomy to 2.4 +/- 0.5 1 year later (P <. 001). Joints with degenerative joint disease (Wilkes stage IV, V) had less satisfactory pain relief compared with stage III joints (3. 6 +/- 0.9 vs 1.1 +/- 0.4, P =.05) and an 11-fold higher risk (P <. 04) for serious residual pain (VAS score >4). Dietary restrictions improved from a mean VAS score of 5.3 +/- 0.7 before the operation to 7.7 +/- 0.5 1 year later (P =.02). Minor differences between mean VAS scores at 1 (2.1 +/- 0.5) and 3 (2.1 +/- 0.5) years for pain, and 1 (7.4 +/- 0.6) and 3 (8.1 +/- 0.6) years for diet, were not significant. Mean maximal interincisal opening was 36.7 +/- 2.0 mm before the operation, and this improved to 40.1 +/- 2.0 mm 1 year later (P <.02). Mean contralateral movement was 8.3 +/- 0.5 mm before the operation and 8.4 +/- 0.6 mm 1 year after the operation (P >.05). None of the 12 Wilkes late III joints progressed to Wilkes IV or V, and none of the 14 Wilkes IV, V joints showed evidence of further bone resorption. The rate for reoperation was 4%. Minor complications occurred in 5 patients and were resolved in all but 1 a year later. When these outcomes were judged by 7 American Association of Oral and Maxillofacial Surgeons assessment indices for internal derangement, the mean rate of favorable outcome was 87%. Modified condylotomy is a safe and effective operation for treating pain and diminished function of temporomandibular joints with nonreducing disk displacement. It also seems to be an effective treatment for slowing further progression of the internal derangement and associated pathologic conditions.