Condylar Hypoplasia - treatment?

[Jal2.0]

Hi fellow "other" category friends

I have condylar hypoplasia and have been aware of it for 14 years now.  I have been through braces twice with the hope of stabilizing it (7 years total!!), and the bone itself is not doing anything, but I am starting to have very bad TMD problems again that went away for a bit after the last round of braces. 

I am finally considering surgery.

As I live in Canada, it is going to be a while until I can get my consult...

So.....

I am wondering what the treatment tends to be for this type of issue?  I have been researching various surgical approaches but I can't seem to find anything for this!  I am expecting I will need upper and lower, but for the lower....do they do a BSSO and take out bone on one side and expand on the other?  Really trying to wrap my head around the cuts that need to be made....


My case is not extreme (5 mm shorter on the right side) but it is bad enough that it is causing me daily headaches, facial pain and sinus issues.  Most people don't notice my chin deviation in person.....but I definitely know it's there!  The cosmetic effects will be a nice side effect but I am looking forward to hopefully just feeling better.

I would love to hear anyone's experience with this!  I'm an RN so please feel free to share all the gory details :p.

Also....how do they know if it's hypoplasia vs hyperplasia?  Bone size? 

Thanks!

Jess

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[strongjawman]

Hey Jess, I also live in Canada (moved here a year ago in March!) but I am going to go private unless I somehow find an amazing surgeon through public healthcare.

I have something similar to you, except my chin is deviated to the left too and the degree of symmetry is more noticeable.

I consulted one surgeon in the UK back in 2012 and had a number of investigations done; a Cone Beam CT Scan, soft tissue analysis, Orthopantogram and a Medicine Bone Scan.

They can test for hyperplasia/hypoplasia with these tests. For me, the 99m Technetium Methylene Diphosphonate scan showed a very subtle difference between the right and left jaw joints, with slightly increased activity in the right jaw joint (My right condyle is slightly longer than my left).

As for the surgical procedure to correct it. I never received a full plan, but the surgeon mentioned it would probably consist of lengthening the left side and shortening the right side. However, after years of research on other patients with similar problems, it seems as though I would also need a lateral genioplasty to correct the chin asymmetry, upper jaw surgery potentially with CCW rotation of the maxilla and then a BSSO. The reason is I have a class i bite on the right side and a class ii on the left with midline deviation.

How is your bite and does your midline align?

[Jal2.0]

Hi

Thanks for the reply!

  We have very similar issues but opposite sides......my midline is not too bad as far as my teeth go, but that is thanks to camouflage orthodontics.  It is off ever so slightly to the right.  as far as my chin medline, i don't have exact measurements as I am awaiting all the fancy tests,  but from my own measurements i believe it is 3 mm off centre.

   I have been researching surgeries and i am wanting to stay away from a bsso if at all possible.  The idea of such a high incidence of nerve damage frightens me to the point that I will live with the TMJ pain and seek other options later in life.  I have read a few studies on asymmetry being corrected with a unilateral IVRO and unilateral SSO......but I am not sure if this is practiced in Canada or if I am a candidate. 

  I am going for a consult in Santa Barbara with Gunson in June as I want to explore this to the full extent before I make a decision.  Do you have any leads on anyone else private who has dealt with cases like ours?

Happy to meet another unilateral condylar hypolasia person

[Ginger]

Hi Jess, my lower jaw was crooked, and my surgeon moved one side back and the other side slightly forward. Before surgery I had similar issues to you -- TMJ pain, jaw pain, and headaches/migraines. It's only been two months since surgery but none of these issues have resurfaced so far.

Good luck with your consults!

[strongjawman]

Hi

Thanks for the reply!

  We have very similar issues but opposite sides......my midline is not too bad as far as my teeth go, but that is thanks to camouflage orthodontics.  It is off ever so slightly to the right.  as far as my chin medline, i don't have exact measurements as I am awaiting all the fancy tests,  but from my own measurements i believe it is 3 mm off centre.

   I have been researching surgeries and i am wanting to stay away from a bsso if at all possible.  The idea of such a high incidence of nerve damage frightens me to the point that I will live with the TMJ pain and seek other options later in life. I have read a few studies on asymmetry being corrected with a unilateral IVRO and unilateral SSO......but I am not sure if this is practiced in Canada or if I am a candidate. 

  I am going for a consult in Santa Barbara with Gunson in June as I want to explore this to the full extent before I make a decision.  Do you have any leads on anyone else private who has dealt with cases like ours?

Happy to meet another unilateral condylar hypolasia person

Do you happen to have links to these papers handy?

This is an interesting paper on correcting hypoplasia of the mandible (different but goes through some similar strategies)

http://journals.lww.com/jcraniofacialsurgery/Abstract/2014/11000/Unilateral_Mandibular_Hypoplasia_in_Adult.6.aspx

As far as surgeons, I'm in the same boat as you! Going to consult with Arnett or Gunson too, maybe Larry Wolford in Texas as well. And then Paul Johnson in the UK.

Will keep you updated as well.