Definition & Overview

Condylectomy is one of the medical procedures used to treat temporomandibular joint (TMJ) disorders or simply TMD. It is a surgical procedure used in cases that involve an organic disease of the said joint. It works by totally removing the condyle.

The TMJ is a condylar joint and is the main joint of the jaw. It connects the mandible and the temporal bone, hence its name. It is made up of mandibular condyles, the articular surface of the temporal bone, an articular disc, a lateral pterygoid, a capsule, and ligaments. The TMJ’s main function is to allow jaw movement. As such, it plays a key role in eating and speaking.

When any of the structures of the TMJ gets displaced or gets damaged for any reason, TMJ disorders develop. Such disorders can be dealt with surgical procedures such as condylectomy.

Who Should Undergo and Expected Results

Condylectomy is beneficial for patients who suffer from temporomandibular joint disorders. These include:

  • Degenerative joint disease (DJD), or diseases that are characterised by inflamed joints and tissues surrounding the jaw
  • Internal derangement, such as disc displacement with reduction
  • Displaced condyle fractures, or when the condyle bone becomes fractured
  • Recurrent luxations, or recurrent dislocations
  • Ankylosis, or the abnormal immobility of a joint resulting from fibrosis or bone union; it can be caused by disease, injury, or surgery.
  • Temporal arteritis, or inflammation of the blood vessels that supply blood to the temporal area (head and neck)
  • Myofascial pain disorder, a painful condition of the TMJ caused by muscle tension and spasms


However, condylectomy is more effective in patients who suffer from organic TMJ disorders or those that are stress-related. These disorders typically cause symptoms such as:

  • Clicking or popping noise when the patient chews or moves his jaws
  • Muscle pain around the jaw
  • Pain around the ear that spreads to the cheeks and temples
  • Headache or migraine
  • Tight or stuck jaw
  • Difficulty opening the mouth
  • Earache
  • Blocked sensation in the jaw
  • Pain in the neck
  • Backache
  • Sleep disturbances
  • Facial asymmetry


TMJ disorders can be caused or aggravated by:

  • Stress
  • Wear and tear of the jaw joint
  • Craniofacial trauma
  • Chronic ear infections
  • Uneven bite, usually caused by a new denture, dental crown, or filling
  • Bruxism, a condition that causes a person to clench his jaw or grind his teeth during sleep
  • Underlying medical conditions, such as osteoarthritis, rheumatoid arthritis, gout, or fibromyalgia


TMJ disorders can be treated without surgery. Patients who experience TMD symptoms are advised to make some lifestyle changes, such as resting the joint, shifting to a soft diet, doing gentle jaw exercises, massaging the muscles around the jaw, and avoiding clenching the jaw or grinding the teeth. Some patients are also given medications or steroid injections. However, some patients eventually require surgery if the disorders do not respond to treatment or if their conditions do not improve.

In a study performed on 17 patients who underwent condylectomy, 14 of them experienced relief from symptoms. The procedure successfully removed any limitations in their jaw motion, allowing them to move their jaw freely afterwards.

How is the Procedure Performed?

Condylectomy, which can be either low or high, works by removing the condyle completely. A high condylectomy is a modified version of the procedure where the bone of the condyle head is simply re-contoured to remove the diseased or damaged part. This is effective in removing any bone irregularities or impingement in the temporomandibular joint. The procedure is commonly performed on the lateral part of the joint.

The procedure usually takes 60 to 90 minutes. After the surgery, the patient is usually advised to stay in the hospital for 24 hours.

Condylectomy is sometimes combined with other procedures, such as a caudal mandibulectomy. This is most effective on patients who have periarticular neoplasia or ankylosis. It can also be performed in conjunction with orthognatic surgery. Condylectomies are also usually followed by a reconstruction procedure.

Possible Risks and Complications

The complication rate of condylectomy procedures for the treatment of TMJ disorders is very low. Most patients undergo the procedure without any complication. In a study involving 14 patients, none of them had any pain during the follow-up visit.

Condylectomy is considered a safe procedure. The potential complications are quite few and are mostly related to the temporal branch of the facial nerve. These include:

  • Scarring, which is usually insignificant and does not cause major aesthetic problems for most patients
  • TMJ noises, which occurred in 3 patients (or 21.4% of the participants in the study)
  • Compromised facial nerve function
  • Facial nerve injury
  • Limited jaw movement
  • Decrease in the vertical dimension of the surgical site, resulting in an open bite

    References:

  • Nelson CL, Hutton CE. “Condylectomy for temporomandibular joint dysfunction. A survey of seventeen postoperative patients.” Oral Surg Oral Med Oral Pathol. 1981 Apr; 51(4): 351-4. https://www.ncbi.nlm.nih.gov/pubmed/6940070

  • Olate S, Martinez F, Uribe F, Pozzer L, Cavalieri-Pereira L, de Moraes M. “TMJ function after partial condylectomy in active mandibular condylar hyperplasia.” Int J Clin Exp Med. 2014; 7(3): 775-779. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992422/

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