Stability of Endoscopic Condylectomy and Costochondral Graft Reconstruction for Condylysis

Objectives: Idiopathic condylar resorption (ICR) often results in deformities requiring temporomandibular joint (TMJ) reconstruction. Reconstructive options include autogenous grafting or TMJ alloplasts. The purpose of this study was to assess the long-term stability of bilateral endoscopic condylectomy and costochondral graft reconstruction for treatment of active ICR.
Methods: This was a retrospective cohort study of all patients with active ICR who underwent bilateral condylectomy and costochondral graft reconstruction at Massachusetts General Hospital between 1999 and 2013. Preoperative (T0), immediate postoperative (T1), 1 year (T2), 2 years (T3), 3-5 years (T4), and 5+ years (T5) follow-up clinical examinations were used to assess functional outcome. Lateral cephalograms and panoramic radiographs were used to evaluate long-term skeletal stability. Cephalometric data were analyzed using the paired t test with Bonferroni correction for multiple comparisons.
Results: There were 27 subjects (24 female, mean age 22.3 years) with active ICR who underwent bilateral procedures without complication. The mean follow-up time was 3.31 years (1 month – 11.6 years). Preoperatively, all subjects had a Class II malocclusion with a mean overbite of -2.50 mm and mean overjet of 6.60 mm. Between T1 and subsequent time points, there was no significant difference in overbite, overjet, SNB, and mandibular plane angle. At latest follow up, 26 subjects had a stable Class I occlusion with a mean maximal incisal opening of 39.1 mm. One subject presented with an anterior open bite (-1.10 mm) 11 years postoperatively.
Conclusions: Stable and predictable long-term outcomes can be achieved using endoscopic condylectomy and costochondral graft reconstruction for treatment of active ICR.