tion of 8 consecutive patients who underwent condylec-tomy and placement of costochondral grafts (n � 14sides) using endoscopic technique. The diagnoses wereidiopathic condylar resorption (n � 6), malunion of afractured condyle (n � 1), and degenerative joint disease(n � 1). Inclusion criteria included condylar pathologyrequiring condylectomy and reconstruction; adequatepre- and postoperative documentation; and at least 6months follow-up. Patients excluded had less than 6months postoperative follow-up, and/or inadequate ra-diographs or clinical documentation. A 1.5-cm incisionwas made directly below the mandibular angle. Thedissection was continued bluntly to the masseter mus-cle, which was incised using a needle point electrocau-tery. Then, with endoscopic elevators, an optical cavitywas created for insertion of a Hopkins endoscope andvisualization of the ramus/condyle unit (RCU). Anatomiclandmarks were identified and the operation carried outwith specially designed endoscopic equipment. Preop-erative (T0), postoperative (T1), and follow-up (T2) clin-ical examinations, lateral cephalograms, and panoramicradiographs were used to evaluate the outcomes.

Results: In all 8 cases condylectomy and CCG recon-struction (n � 14 sides) was successfully performedusing the endoscopic approach. The mean follow-upperiod was 17 months (range 8 to 38 months). Meanoperating time was 52 minutes per side (range 25 to 75minutes) and the average length of stay for all patientswas 2 days (2 to 4 days). No intraoperative or long-termpostoperative complications were encountered in any ofthe patients. One patient experienced transient marginalmandibular nerve weakness post-operatively that re-solved within 2 weeks. Panoramic radiographs docu-mented postoperative RCU position and lateral cephalo-grams documented mandibular position and closure ofthe anterior open bite. Measurements made from lateralcephalograms at T0 revealed that all 8 patients presentedwith a Class II malocclusion, mean RCU length was 4.6cm, and mean openbite and overjet were 2.3 mm and 8mm, respectively. At T1 all patients demonstrated ClassI occlusion; a mean RCU length of 5.6 cm; overbite of 1.0mm; and overjet of 2 mm. At T2 all patients maintaineda Class I occlusion; mean RCU height was 5.4 cm; over-bite was 1.8 mm; and overjet was 2.7 mm.

Conclusion: The results of this case series indicate thatendoscopic condylectomy and CCG is feasible with min-imal morbidity and short-term stability comparable tostandard techniques.

References

Troulis MJ, Kaban LB: Endoscopic approach to the ramus/condyleunit: Clinical applications. J Oral Maxillofac Surg 59:503, 2001

Troulis MJ, Nahlieli O, et al: Minimally invasive orthognathic surgery:Endoscopic vertical ramus osteotomy. Int J Oral Maxillofac Surg 29:239, 2000

Funding Source: Hanson Foundation, NIH K23 Grant DE14070A01,AO-ASIF Foundation, Synthes Maxillofacial.

Indication for Intraoral Vertical RamusOsteotomy (IVRO): A Follow-Up ReportJeffrey Watson, DDS, Department of OMS, DalhousieUniversity, Halifax, NS B3H 3J5 Canada (Morrison A;Precious DS; Goodday R)

Problem: The IVRO has been reported to providesignificant relief from temporomandibular joint (TMJ)pain and dysfunction when conservative therapy hasfailed. In 1999, Chiarot presented a preliminary reportthat retrospectively reviewed 23 patients who had un-dergone the IVRO procedure. His results demonstratedthat patients diagnosed with anterior disc displacementwith reduction (Group I; n � 9) had a 100% success rate.He also reported that patients with significant TMJ dys-function without displacement (Group II; n � 14) had a71% success rate. Although the results were very prom-ising, the mean follow-up time was only 14 and 16months, respectively. Therefore, it is unknown whetherthese patients still enjoy the same degree of pain reliefseveral years post-operatively.

Purpose: Assess longer-term outcomes of a previouslyreported series of patients who underwent IVRO for TMJpain and dysfunction.

Methods: Patients who had IVRO between April 1996and November 1998 at the Department of Oral andMaxillofacial Surgery, Dalhousie University, were retro-spectively reviewed. All patients in this study failed con-servative therapy and were subsequently treated byeither unilateral or bilateral IVRO. All patients were con-tacted by phone and consented to a standard question-naire devised by the author. Outcome parametersconsisted of assessing joint pain and TMJ clicking pre-and postoperatively. Success was defined as significantreduction or complete resolution of the patient’s painand clicking.

Results: Nineteen of the original 23 patients werecontacted for reassessment. Seven patients from Group Icompleted the phone interview with a mean follow-upof 64 months. Six patients reported the surgery to be asuccess and one deemed it a failure. The lone failure inthis group was originally reported as a success in thepreliminary report. In Group II, 12 patients completedthe phone interview with a mean follow-up of 69months. Ten patients reported the surgery to be a suc-cess and 2 deemed it a failure. The 2 failures in Group IIhad been recorded as failures in the preliminary report.Therefore, only 1 of the 19 patients contacted had re-gressed to pre-surgical pain levels between the initialreport and follow-up assessment. Using the McNemar’stest for changes, this was not statistically significant (P �1.000).

Conclusion: With 16 of 19 patients (84%) reportingsuccess several years post-operatively, this study sug-gests the IVRO is a reliable treatment for TMJ pain anddysfunction when conservative treatment has failed. It

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64 AAOMS • 2003

also suggests that results obtained 1 year post-opera-tively are reliable predictors of future levels of success.

References

Bell WH, et al: Treatment of temporomandibular dysfunction byintraoral vertical ramus osteotomy. Int J Adult Orthod OrthognathicSurg 5:9, 1990

Chiarot MA: Indications for intraoral vertical ramus osteotomy(IVRO): A preliminary report. Oral Abstract Session 13, J Oral Maxillo-fac Surg 1999

Funding Source: John P. Laba Memorial OMFS Research Fund.

Osteochondroma of Mandibular Condyle:Conservative Reconstruction withCondylectomyEber L. L. Stevao, DDS, PhD, 5322 Greyson Drive,Garland, TX 75043 (Wolford LM; Morales-Ryan CA)

Mandibular condylar osteochondroma is a unilateralbenign pathological condition, with proliferation of os-seous and cartilaginous components through the head ofthe condyle, causing enlargement with extensions thatcan develop in any direction off of the condyle. It is aprogressive pathology often resulting in significant facialdeformity, pain, and masticatory and occlusal dysfunc-tion. Traditional treatment options include condylec-tomy and condylar replacement with rib graft or totaljoint prosthesis. This investigation evaluated the out-come of a more conservative treatment eliminating theneed to harvest a graft or place a prosthetic joint.

Methods: The study consisted of 15 patients (11women and 4 men) with average age of 25.6 years (13 to44 years) and osteochondroma of either their right con-dyle (n � 6) or left condyle (n � 9). Imaging studiesincluded panoramic, standardized cephalometric tomo-grams, and lateral cephalometric radiographs preopera-tively and postoperatively. The diagnosis for osteochon-droma was confirmed in each patient by histopathologicanalysis. All patients had 1) resection of the condylarhead, 2) recontouring of the condylar neck to form anew condyle, 3) articular disc repositioning over thecondylar stump, and 4) indicated orthognathic surgicalprocedures for repositioning of the condylar stump anddisc into the fossa and correcting other associated dento-facial deformities. Postoperative follow-up averaged 36months (6 to 108 months).

Results: All but one patient required double jaw sur-gery to correct the associated jaw deformities. At longestfollow-up, maximum incisal opening increased an aver-age of 3.6 mm, whereas contralateral excursive move-ments decreased an average of 1.3 mm. Fourteen pa-tients maintained a stable dentoskeletal relationship anda Class I dental occlusion postsurgically, and 1 patientexperienced a 3 mm anterior open bite when seen at 5years postsurgery secondary to orthodontic relapse,which was subsequently corrected orthodontically. No

recurrence of the tumors occurred in any of the patients.The table lists the average values and ranges:

Age(yr)

Follow-up(mo)

IncisalOpening (mm)

ContralateralMovement

(mm)

Preop 25.6 (13-44) 45.2 (11-66) 5.5 (0-8)Postop 36 (6-108) 48.8 (35-61) 4.2 (0.6)

Conclusions: This is the largest study available on thetreatment of osteochondroma and demonstrates that con-servative condylectomy procedures with recontouring ofthe condylar neck to function as a condyle, repositioning ofthe articular disc, combined with orthognathic surgeryappears to be a viable option for the treatment of osteo-chondroma of the mandibular condyle.

References

Henry CH, Granite EL, Rafetto LK: Osteochondroma of the mandib-ular condyle: Report of a case and review of the literature. J OralMaxillofac Surg 50):1102, 1992

Karras SC, Wolford LM, Cottrell DA: Concurrent osteochondroma ofthe mandibular condyle and ipsilateral cranial base resulting in tem-poromandibular joint ankylosis: Report of a case and review of theliterature. J Oral Maxillofac Surg 54:640, 1996

The Use of Silicone Block as aTemporary Spacer in TMJ SurgeryMichele Bergen-Shapiro, DMD, MD, UMDNJ,Department of OMS, 110 Bergen Street, Room B-854,Newark, NJ 07103 (Hoffman DC)

Introduction: The purpose of this study is to evaluatethe surgical outcomes of 14 patients who underwentstaged TMJ reconstruction using a silicone block spacerand subsequent replacement with a total joint prosthe-sis.

Materials and Methods: The patients included in thisstudy underwent a staged TMJ reconstruction because ofthe need for removal of existing hardware or autologousgrafts, and fibrous or bony ankylosis. During the firstportion of the procedure, the condylar head and neck,autologous graft, or existing hardware, were removed,along with any residual discal tissue. A compressiblesilicone block spacer of 10 derometers (soft) was cutfrom a silicone carving block. The approximate size of1 to 2 cubic centimeters was dependent upon the sizeof the patient and surgical resection. It was placed inthe glenoid fossa and secured to the zygoma usingminiplates and screws. Postoperatively, the patient un-derwent a 3-D CT scan for the fabrication of a customtotal joint prosthesis. During the second procedure theblock spacer was removed, surrounding tissue sent forpathologic evaluation, and the final TMJ prosthesis wasplaced. The patients were evaluated for the duration ofmaintenance of the block, final outcome, as well ashistological analysis of surrounding tissue.

Results: A total of 24 silicone blocks were placed in 14

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