Active condylar hyperplasia, having condylectomy in 10 days. Nedd some opinion.

[karenchiu18]

Hi everyone. I'm glad I came across this forum as I finally sat down to do some research for my surgery in 2 weeks.

Some background: I had malocclusion problems that I had orthodontics for when I was about 16. I'm not as clued up on the lingo as you guys are but I think I was class III. I don't know what I am now but my orthodontist is happy with my bite (I still wear a wire behind my lower teeth but the work is essentially done), which is by no means perfect aesthetically (my dental midlines don't match up) but I can cope.

I'm now 22. In the past couple of years I had the feeling that something wasn't quite right with my face, that it wasn't symmetrical. It was hard to pinpoint exactly where the problem was without relevant knowledge, and I've been told by friends the my asymmetry is not very visible. I thought it was just a variant of normal as most people have slight asymmetry in their face.

Here's my pic: http://imgur.com/a/xldXq

My jaw swings to the right. I have a compensatory occlusal cant and my lower teeth point towards my left jaw. Looking from a slight angle from the left and right, my face looks quite different (I look like I have a longer face from the left due to vertical growth).

I work in the hospital and was spot diagnosed by a maxillofacial surgeon to have condylar hyperplasia. I went to see him at his practice, and have had a scintiscan (technetium) that determined my left mandibular condyle is still growing. So in 10 days I'm having a condylectomy to take the active growth plate in the condyle out. I'm in New Zealand and this surgery is through the public system as my insurance company wouldn't cover it - they say the problem was "pre-existing" (my jaw would have been growing since puberty, just never stopped). I'm lucky I guess because the active growth makes it a "medical" problem rather than purely cosmetic.

I trust my surgeon (the one that spot diagnosed me) as he says he treats patients with condylar hyperplasia in the region. And also because he diagnosed me within 10 seconds of meeting me, whereas the maxillofacial surgeon I saw when I was 16 did not

Sorry for the long background. Basically I did some research and saw the sort of stuff you guys went/are going through and it freaked me out a little. My surgeon said he would first do a condylectomy (no cuts in skin, done from inside mouth) to stop the growth. Then reassess appearance in 3-6 months and do any cosmetic procedures then (I think he was describing genioplasty +/- inferior border oesteotomy) as oftentimes taking height from the condyle during condylectomy (I'm having 1cm resected) swings the jaw back and corrects the asymmetry to a degree. Remodelling of bones due to changes in loading after surgery, and change in proprioception hence the way I hold my jaw also occur that offset the asymmetry too he said.

The condylectomy is no minor surgery, but he made the whole process sound quite straightforward. He also said I wouldn't need further orthodontics. I'm confused about that because I've had orthodontics to correct my bite despite the underlying jaw problem. If the jaw problem gets partially fixed, will my teeth still match up? Also this has been a long term enough problem that my left maxilla has tried to compensate by growing, as evidenced by the cant in my teeth.

Does what my surgeon's doing seem reasonable? Is it the case that my problems are not as serious as what some of you have, so is managed differently? Or maybe it's more of a case of the difference between insurance in the states and limited medical resources in NZ? I do not have any functional problems yet (although knowing the problem I have now, I sometimes feel pain in my left TMJ but meh), so it's more preventative and cosmetic, unlike some of you who need prognathic surgery for functional problems.

Anything that sounds alarm bells in your head in the management plan? I'm sorry about the long text. My less than adequate knowledge in this area makes it hard to be succinct and know what questions to ask. I just need some reassurance that I'm going down the right path I guess. If everything in the management plan seems reasonable I guess I'll just have to accept that the result won't be perfect unless I undergo expensive major surgery.

[Marisama]

I'm a bit skeptical of your treatment plan.  I am not a medical expert but I have been to numerous consultations for condylar hyperplasia, although mine is no longer active as I am a bit older than you.  It looks to me that you have some upper jaw asymmetry.  A condylectomy does not do anything to address this.  You are going to have a shorter vertical ramus due to the 1 cm shortening, but you are still going to be left with an occlusal cant. 

[karenchiu18]

Thanks for quick response I came across your blog during my research actually which brought me to this forum.

This is my understanding of my situation: Because my condylar hyperplasia is still active, unless I want to wait until the growth ceases before any surgery (and everything will likely get worse), the only option is to take the growth plate out, hence the condylectomy (the added benefit of correcting some of the asymmetry is only secondary). Anything else would be cosmetic, as I don't have any functional problems. I agree I do have upper jaw asymmetry, which likely resulted from compensating for the condylar hyperplasia.

The problems that most bothered me were the asymmetry in the lower jaws and chin. The surgeon did not promise the condylectomy would correct all of the asymmetry, but did say the lower jaw asymmetry usually becomes less obvious because of the shortened ramus, bone remodelling and changes in the way I hold my jaw (from brain signals, not consciously) over time. He usually reassesses the need for further cosmetic surgery after half a year, even for his private patients. It's different from most on this forum who went in and had everything corrected in one go. I don't know why that is, maybe it's because my problems are not functional. Maybe it's because of limited health resources in NZ, and scrutiny by insurance companies.

Thanks for your opinion, I'll definitely ask my surgeon how things will go after the condylectomy. The next time I see him will be on the day of the surgery though I think either way, whether I have subsequent cosmetic surgery or not, the condylectomy needs to be done. I just wish I could ask him all these other questions I have!

Good luck for your surgery too, if you haven't had it! I remember you said October in one of the threads.

[Marisama]

I'm glad the blog is good for something!  As long as you are considering orthognathic surgery later on to fix your problem, then maybe it's an okay route to take.  I do know that some surgeons perform high condylectomy alongside orthognathic surgery.  Dr. Wolford, one surgeon I consulted with, is one of the surgeons who does this, and he proposed this route for me back when I was 22 or so.  My jaw has not grown much at all since that time, so I'm very glad that I did not operate on my joints.  If I were in your shoes, which I was at one time, I would want to avoid joint surgery at all costs and prevent any can of worms like that.  I was told by my current surgeon that operating on the joint can potentially cripple your jaw for good.  If you aren't having any functional issues, I would think long and hard about your decision.

I hope you've done enough research because these things are irreversible.  

[karenchiu18]

Wow that must have sounded scary. Funnily enough that wasn't one of the complications my surgeon warmed me about if I recall correctly. I will be sure to ask about that. Was that advice directed at you based on your clinical condition (because you already had joint problems)? Or is that something your surgeon would say to anyone? I work in healthcare and know from experience that surgeons will sing more praises for what they believe in, and often exaggerate risks of the alternative. And who could blame them? They truly believe in it and you gotta be passionate about what you believe in.

I did a search after reading your response and guess what I found? None other than the man himself.
http://www.ncbi.nlm.nih.gov/pubmed/11840126

But the average age at operation was 17.5 years and these patients still had active hyperplasia. Did you have a scan at age 22? Was your mandible still growing back then or were you only assessed clinically?