Technical NoteTMJ Disorders
Modiﬁed trans-oral approach formandibular condylectomy
M. Deng, X. Long, A. H. A. Cheng, Y. Cheng, H. Cai: Modiﬁed trans-oral approach for mandibular condylectomy. Int. J. Oral Maxillofac. Surg. 2009; 38: 374–377.
2009 International Association of Oral and Maxillofacial Surgeons. Published byElsevier Ltd. All rights reserved.
,A. H. A. Cheng
, Y. Cheng
, H. Cai
Department of Oral & Maxillofacial Surgery,Key Lab for Oral Biomedical Engineering ofMinistry of Education, School and Hospital ofStomatology, Wuhan University, Wuhan,Hubei Province 430079, PR China;
Oral andMaxillofaical Surgery Unit, Royal AdelaideHospital, Adelaide, Australia
Differentapproachestothemandibularcondylehavebeendescribed.Inthis paper,amodiﬁedtrans-oraltechniquetoaccessthemandibularcondyleisdescribed and illustrated. This technique was used in a small group of patients; the clinicaloutcomes are promising. The technique can be used in various temporomandibular joint (TMJ) operations, such as condylar resection, high condylectomy or tumor removal. It provides adequate intra-oral surgical access to the mandibular condyleand avoids complications from extra-oral approaches to the TMJ.
Keywords: trans-oral approach; condylectomy.Accepted for publication 16 January 2009Available online 17 March 2009
Mandibular condylectomy is widely used for treating temporomandibular condylediseases. Extra-oral approaches, such as pre-auricular, posterior aur icular and submandibular approaches
, are com-monly used by clinicians. The intra-oralapproach to the temporomandibular joint(TMJ)was ﬁrst reported by Sear in1972
et al. also used this accessfor TMJ cond ylar osteochondroma resec-tion in 1977
described an intra-oral condylectomytechnique using standard instrumentationfor intra-oral vertical ramus osteomy in1989
. Intra-oral condylectomy avoidsfacial nerve injury and facial scarring.There are no descriptions of this techni-que in recent publications. The trans-oralapproach to the TMJ is useful for acces-sing the condyle and potentially haslower morbidity than extra-oralapproaches. The technique is easy tolearn, based on experience from mandib-ular osteotomy.From September 2006 to June 2007, 6 patients underwent condylectomy using atrans-oral approach at Wuhan University.The clinical diagnoses included mandib-ular condylar osteochondroma (2 cases)and condylar hyperplasia (4 cases)(Table 1). All the diagnoses were sup- ported by symptoms, physical examina-tion, radiographic images and histopathology. All patients who partici- pated in the study had good outcomesintra-operatively and postoperatively.
Case presentation and surgicaltechnique
A 41-year-old woman presented withfacial asymmetry and trismus in Septem- ber 2006. The left side of her face wasnotably elongated. The mandibular mid-
Int. J. Oral Maxillofac. Surg. 2009; 38: 374–381?
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. Patient details.Patientno.Age(years) Gender Diagnosis ComplicationsMMO (mm)Pre-op post-op (m)1 25 F OC S, MOL, MO 30 28 (3)2 15 M CH S, MOL, MO 35 no3 21 F CH S, MOL, MO 48 35(3)4 24 M CH S, MOL, AC, MO 40 40 (8)5 22 F CH S, MOL, AC, MO 30 46(6)6 41 F OC S, MOL, MO 34 42(6)AC: angular cheilitis; CH: Condyle hyperplasia; m: month; MMO: maximum mouth opening;MO: malocclusion; MOL: mouth opening limitation; OC: osteochondroma; S: swelling.
2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.