Prospective study of modified condylotomy for treatment of nonreducing disk displacement

Objective, This study was performed to provide an objective assessment of t he outcome of modified condylotomy for treatment of the painful temporomand ibular joint with nonreducing disk displacement (Wilkes late stage III, IV, V). Study design, A prospective study of 31 consecutive patients (43 joints) wa s conducted. All patients had nonreducing disk displacement verified by mea ns of disk imaging. Independent evaluations were performed to assess pain, dysfunction, and progression of disease. The examinations were performed be fore modified condylotomy and at intervals up to 1 year after the operation . Eighteen patients (26 joints) completed the required examinations. Patien t-based assessments were completed for pain and diet on 15 of these 18 pati ents (23 joints) 3 years after the operation. Results. Visual analog scale (VAS) scores (mean +/- SE) for pain improved f rom 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 le ss 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 resi dual pain (VAS score >4). Dietary restrictions improved from a mean VAS sco re 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 It 0.5) years for pain, and 1 (7.4 +/- 0.6) and 3 (8.1 +/- 0.6) years for d iet, 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 lat er (P < .02). Mean contralateral movement was 8.3 +/- 0.5 mm before the ope ration 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 f or 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 Am erican Association of Oral and Maxillofacial Surgeons assessment indices fo r internal derangement, the mean rate of favorable outcome was 87%. Conclusion, Modified condylotomy is a safe and effective operation for trea ting pain and diminished function of temporomandibular joints with nonreduc ing disk displacement. It also seems to be an effective treatment for slowi ng further progression of the internal derangement and associated pathologi c conditions.