SA2 - Improved Quality of Living Following Simultaneous Condylectomy and Orthognathic Surgery: A Retrospective Analysis for Active Unilateral Condylar Hyperplasia

Abstract: The objective was to assess quality of life in patients who underwent simultaneous condylectomy and orthognathic surgery in conjunction with orthodontic treatment for active unilateral condylar (TMJ) hyperplasia. This pathologic process leads to the development of esthetic and functional concerns. High condylectomy (7-10mm of bone removed from condylar process) simultaneously performed with orthognathic surgery is the treatment studied1, but currently, there is no published literature that analyzes patient satisfaction.

A total of 51 patients who underwent simultaneous condylectomy and orthognathic surgery for active unilateral condylar hyperplasia at UNC hospitals between 2004 and 2017 (minimum 4 years postop) were mailed a questionnaire containing 21 questions to assess their quality of life after undergoing treatment. All patients underwent orthodontic treatment in conjunction with surgery.

A total of 24 (47%) patients completed and returned the questionnaire. Sixteen (67%) were female and 8 (33%) were male, similar to the treatment population. Twenty-three (96%) reported that they are satisfied with their results. Even after fully realizing the consequences of treatment, these 23 respondents endorsed that they would do it again. Benefits of treatment included appearance change, improved mastication, reduction of discomfort, and improvement of jaw functioning, etc. Indication for treatment differed for each patient, but when polled on their greatest benefit derived from treatment, 13 (54%) reported appearance change, 18 (75%) reported improved mastication, and 7 (29%) reported reduction of discomfort (10 respondents provided more than 1 “greatest benefit”). Overall, 8 (33%) patients endorsed TMJ pain prior to surgery, and 4 (50%) of those individuals reported that they no longer suffer from TMJ arthralgia of any magnitude. Furthermore, 9 (38%) patients reported “clicking” prior to treatment, with 12 (50%) reporting “clicking” afterwards. Of the 24 surveyed patients, 9 (38%) reported frequent headaches prior to treatment. All of these individuals reported a decrease in frequency and intensity of headaches since treatment. Based on the pre-operative clinical findings of the 24 patients, 13 (54%) patients were classified Hemimandibular Elongation, 4 (17%) were Hemimandibular Hypertrophy, and 7 (29%) were a hybrid of Hemimandibular Elongation and Hemimandibular Hypertrophy, according to the Obwegeser and Makek classification2 of condylar hyperplasia.

Overall, a significant majority of patients undergoing simultaneous condylectomy and orthognathic surgery combined with orthodontics benefited from treatment. This is important for healthcare providers when considering referral for condylar hyperplasia. Prior to these data, treatment was agreed upon between provider and patient based on the practical idea that surgical intervention will improve quality of life. Now, potential patients can be educated on tangible treatment outcomes when determining whether to pursue treatment, regardless of their presenting concern.

References:
1. Wolford LM: Concomitant temporomandibular joint and orthognathic surgery. Journal of oral and maxillofacial surgery 61(10):1198-1204, 2003
2. Obwegeser, L: Hemimandibular hyperplasia - hemimandibular elongation. Journal of Maxillofacial Surgery 14:183-208, 1986