The high condylectomy arrests the excessive and disproportionate growth of the mandible by surgically removing one of the important mandibular growth sites and the site responsible for the CH type 1 pathological growth process (4) (Figure 4).
Group 1 patients (n = 12) were treated with orthognathic surgery only and group 2 patients (n = 25) were treated with high condylectomy articular disc repositioning, and orthognathic surgery.
There were five criteria for inclusion in the study: 1) confirmed active CH type 1 based on serial clinical and radiographic evaluations (serial lateral cephalograms and lateral temporomandibular joint [TMJ] cephalometric tomograms); 2) bilateral or unilateral high condylectomy to remove the active growth center and articular disc repositioning for group 2; 3) orthognathic surgery to correct the associated dentofacial deformity; 4) at least 2 years of postsurgical follow-up; and 5) adequate clinical and radiographic records for analysis.
Group 1 patients (n = 12) were treated with orthognathic surgery only, while group 2 patients (n = 42) had high condylectomy procedures, articular disc repositioning, and orthognathic surgery.
The high condylectomy stops forward growth of the mandible, with only normal appositional growth remaining at pogonion and vertical alveolar growth if the surgery is performed before normal facial growth is completed (4, 15).
Surgically eliminate further mandibular CH growth with a high condylectomy (removing 3 to 5 mm of the superior aspect of the condylar head including the medial and lateral poles) (Figures 3b, 4 IOb) and simultaneous orthognathic surgery (4); this was the treatment used for all patients in group 2.
The high condylectomy procedure will alter the position of the mandible to the maxilla since vertical height of the condyle is removed.
Thus, it doesn't matter how much the mandible is displaced with the high condylectomy procedure; the mandible is still placed in the same final position.
A unilateral high condylectomy will arrest growth on the operated side, but normal growth can continue on the contralateral side and could cause development of facial and occlusal asymmetry after surgery if the surgery is performed while normal growth is still occurring.
The results from our study demonstrate that the high condylectomy (with removal of the top 3 to 5 mm of the condylar head) in the treatment of active CH type 1 patients arrests the abnormal growth and provides highly predictable long-term outcomes.
At surgery, an endaural or preauricular approach was used to perform the condylectomy
, joint debridement, coronoidectomy to release the temporalis muscle, and, if indicated, accurate bony recontouring of the fossa as dictated by the recontouring done on the CAD/CAM model.