Condylotomy has been shown to work most favorably in cases of anterior disc displacement, especially in the setting of disc displacement with reduction. Modified condylotomy can effect disc reduction and alter favorably the natural course of internal derangement in reducing disc displacement A posteriorly directed osteotomy is more likely to be associated with excessive condylar sag, if not condylar displacement by unopposed lateral pterygoid activity. Medial pterygoid muscle is deliberately stripped from the inferior aspect of the proximal segment to produce condylar sag with modified condylotomy. To minimize ir prevent condylar sag, lateral pterygoid stripping is minimized in vertical ramus osteotomy for mandibular setback. Bite disturbance is minimized with a brief (1 week –unilateral, 2-3 weeks-bilateral) period of maxillomandibular fixation followed by a period (3-4 weeks-bilateral, 5 weeks-unlateral) of training elastic use. Bite disturbance is more common in the setting of bilateral condylotomy, pre-existing malocclusion, and missing molars on the operated side. Ligation of anterior teeth can allow for dental compensation and minimize open bite malocclusion especially after bilateral condylotomy.
- Condylar “sag” and loss of ramus height can lead to a posterior occlusal prematurity on the side of a modified condylotomy. Occlusion changes following discectomy, if any, are mild and transient. Joint noise is more common after discectomy because of intraarticular scarring/adhesions.
- The mean distance from the internal maxillary artery to the midsigmoid ramus is only 3.3 mm. In addition to the risk of injury to the internal maxillary artery, a branch of the internal maxillary artery, the masseteric artery, passes through the sigmoid notch to supply the masseter muscle. Both arteries are at risk during modified condylotomy.
