Treating TMJ disorders with a Modified Condylotomy surgical procedure
Special Report to Leadingdentists.com: reviewed for accuracy by Dr. Mark Duncan; DDS, FAGD, DICOI, LVIF
If you have been diagnosed with TMJ disorder (TMD), you may have heard of a surgical treatment called a modified condylotomy, and you may be wondering if it could be right for you. Our interview with Dr. Mark Duncan DDS, FAGD, DICOI, LVIF; and Clinical Director at LVI Global discusses the details of this surgery and what treatments most sufferers should try before having a modified condylotomy or modified condylectomy.
Modified Condylotomy Facts
This is an open surgical procedure that is performed through the mouth and behind the molar teeth. The name of the procedure is actually a misnomer, since the mandibular condyle — a rounded projection at the end of the lower jaw — itself is not cut. The surgeon creates a vertical cut in the lower jaw, or mandible, in order to create more joint space. The goal is to unload the joint, while maintaining an unchanged occlusion, and thereby to decrease the symptoms of TMD.
After this surgical procedure, patients have an initial recovery period of about six to eight weeks, followed by a full recovery period that can last up to a year. The problem is that after that recovery period, TMJ symptoms can return in full force.
Why? The surgery may not be warranted — and therefore not effective in relieving TMJ disorder symptoms — in more than 90 percent of the cases.
“What we have found is that most of the time (with modified condylotomy), you are addressing the wrong problems in the first place,” says Dr. Mark Duncan of TMD Surgeries. “It is only after all non-surgical options have been exhausted that you should consider having this surgery.”
Referencing groundbreaking studies by Janet Travell, MD, an American physician and medical researcher who treated President John F. Kennedy, Duncan says that 85 to 90 percent of all pain in the body originates with the muscles. He explains that a surgery that cuts out part of the disk or the mandible does nothing to deal with any existing muscle problems and, in fact, can make those problems worse.
“We need to start with the muscles,” Duncan asserts. “We want to get the muscles to the point of physiological rest, where they are designed to be.”, which is in fact the goal of neuromuscular dentistry.
To illustrate this point, Duncan explains, “If it’s the muscles of mastication being too short that’s causing the problem and the surgery moves the bone around the muscle without fixing the muscle, the patient is going to have the post-surgical healing to go through and (then) have all the same symptoms that they had in the first place.”
One non-surgical way of treating TMD that Duncan mentions is the use of a mouthguard, or orthotic, to “recalibrate” the bite so that muscles in the lower jaw can be in a relaxed position when not in use. “When that happens,” he says, “the pain goes away.”
“I would tell you that it is irresponsible for me to ever start a case with a surgical endpoint in mind. I must explore non-surgical options first,” Duncan emphasizes. Not only can non-surgical options treat TMD problems effectively in most cases, he says, but also they do so with a much shorter recovery and healing time.
What to consider before TMJ surgery?
We asked “If you are suffering with painful TMD symptoms, what are some steps to consider before surgery?”.
First, Duncan recommends CT imaging of the soft tissues of the mouth, calling it an important and relatively inexpensive first step. The next step would be to get an MRI, which can provide an assessment of any bone involvement in the TMJ jaw pain.
A third step is to use EMG (electromyogram) data. An EMG measures the activity of muscles both at rest and during contraction. “EMG data lets you look at the comfort level of four muscle groups in the jaw,” Duncan says. “If the jaw muscles are contracting when they should be at rest, you probably do not have a sound bite…We can make some really good decisions with this data.”
The best non-surgical approach to TMJ treatment is the use of a removable mouthpiece or orthotic. “This allows us to see what happens when everything is at rest,” Duncan says. “If all symptoms go away (with the mouthpiece), we can move into a long-term solution.”
Estimating that non-surgical options work for TMD patients 90 percent of the time, Duncan continues, “The invasive end point shouldn’t be considered until we have determined if we can find a better bite for you.”
When is jaw surgery warranted to treat a TMJ disorder?
“We use the catch phrase ‘internal derangement,’” says Duncan, explaining that patients who have a disc displacement of the temporomandibular joint may require surgery. Other cases that might benefit from a modified condylotomy include:
- degenerative disease, such as osteoarthritis of the temporomandibular joint
- cancerous bone or tissues
- recurrent re-seating (luxation) of the ball in the socket when the TMJ pops out of place
- recurrent calcification of the bone
It is important to realize that a modified condylotomy treats the lower jaw only. Duncan suggests that neuromuscular investigation and diagnosis should include the upper jaw. “Ancient man had much larger (mouth) arches, and today we don’t even have room for our wisdom teeth,” he points out.
Duncan maintains that it is inappropriate that many orthodontists today tell their patients that they have “too many teeth” for the size of their mouth. “A better approach would be to say, “Your jaw has not grown enough to hold all your teeth,” he says.
“The upper jaw rules the roost – where the upper jaw is, the lower jaw has to follow.”
Duncan concludes saying, “If we can work to develop the upper jaw, we will see most lower jaw problems all but disappear.”
To learn more about temporomandibular joint disorder treatments, symptoms or to find a local neuromuscular dentist continue your visit with Leading Dentists.