Document Detail

One- and three-year prospective outcome study of modified condylotomy for treatment of reducing disc displacement.
MedLine Citation:
PMID:  10632159     Owner:  NLM     Status:  MEDLINE    
PURPOSE: This outcomes study was designed to provide a comprehensive evaluation of modified condylotomy for the treatment of the painful temporomandibular joint with reducing disc displacement (Wilkes stage II, early III). PATIENTS AND METHODS: A prospective study of 48 consecutive patients (79 joints) was conducted. All reducing disc displacements were verified by disc imaging. Independent evaluations were performed to assess pain, dysfunction, and progression of disease before modified condylotomy and at intervals up to 1 year after operation. Thirty-one patients (50 joints) completed the examination before the operation and 1 year later. Patient-based assessments were made for pain and diet in 22 patients (35 joints) 3 years after operation. RESULTS: The mean (+/- SE) visual analog scale (VAS) score for pain improved from 6.9+/-0.4 before modified condylotomy to 2.0+/-0.4 1 year later (P < .001). Serious pain (VAS score greater than 4) after operation was 7 times more likely (P < .04) when there was persistent disc displacement. The mean frequency of pain each day decreased from 14.6+/-1.4 hours to 4.8+/-1.3 hours (P < .001). Dietary restrictions improved from a mean VAS score of 6.1+/-0.5 before operation to 8.8+/-0.3 at 1 year (P < .001). Small differences between mean VAS scores for pain at 1 (2.0+/-0.5) and 3 (2.7+/-0.5) years and diet at 1 (8.6+/-0.4) and 3 (8.4+/-0.5) years after operation were not significant. Mean maximal incisal opening was 41.7+/-1.2 mm before operation and 43.5+/-1.1 mm 1 year later, but the difference was not statistically significant. Mean contralateral movement improved from 8.1+/-0.3 mm to 8.9+/-0.3 mm 1 year after operation (P < .05). Clicking was reduced from 64% of joints to 16% 1 year after operation (P < .001). The disc was reduced in 72% of joints, healing of an incipient degenerative lesion occurred in 1 joint, and there was no evidence of progression to nonreducing disc displacement (Wilkes late III, IV, V) or DJD (Wilkes IV, V) in any joint 1 year after modified condylotomy. The rate for reoperation was 4%. Complications occurred in 4 patients after operation and were resolved 1 year later. When these outcomes were judged by 7 AAOMS assessment indices for internal derangement, the mean rate of favorable outcome was 94%. CONCLUSION: Modified condylotomy is an effective operation for treating pain and diminished function of temporomandibular joints with reducing disc displacement. It is also an effective treatment for slowing and, in some cases, reversing the progression of internal derangement.
H D Hall; E Z Navarro; S J Gibbs
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons     Volume:  58     ISSN:  0278-2391     ISO Abbreviation:  J. Oral Maxillofac. Surg.     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-01-13     Completed Date:  2000-01-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8206428     Medline TA:  J Oral Maxillofac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  7-17; discussion 18     Citation Subset:  AIM; D; IM    
Vanderbilt University School of Medicine, Nashville, TN 37232-5225, USA.
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MeSH Terms
Analysis of Variance
Disease Progression
Dislocations / surgery*
Facial Pain / etiology,  surgery*
Malocclusion / etiology
Mandibular Condyle / surgery*
Middle Aged
Odds Ratio
Oral Surgical Procedures / adverse effects
Outcome Assessment (Health Care)
Pain Measurement
Prospective Studies
Range of Motion, Articular
Temporomandibular Joint Disk / injuries,  pathology*,  radiography
Temporomandibular Joint Disorders / complications,  physiopathology,  radiography,  surgery*
Comment In:
J Oral Maxillofac Surg. 2001 Aug;59(8):961-2   [PMID:  11474467 ]
J Oral Maxillofac Surg. 2000 Jun;58(6):701   [PMID:  10847298 ]

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