Relapse because of tmj's

[Fowler]

Hello

I have researched and have found out that bimaxillary surgery can relapse due to the tmj's but was wondering what people's take on here is?

Reason I ask is that I had to have a condoylectomy performed due to a bony spur in my tmj (tmj ankylosis). I have read people have had bimax done after having the ankylosis sorted. However, I went to discuss bimaxillary surgery with Mr Piet Haers and he said that bimax couldn't be done due to the condoyle being removed.

I have spoken to the surgeon who performed the condoylectomy and she seems to think this is nonsense. I'm siding with Piet Haers and am looking to make a formal complaint with the NHS as it seems more of my TMJ was removed than what was discussed.

Just wanted to get some advice on here and if people agreed that bimaxillary surgery would have a high chance of relapse due to tmj weakness / condoyle being removed.

[face_backward]

I'm not aware of any research on the feasibility/stability of bimax in the context of condylectomy without joint replacement.  The approach of Wolford and followers, wherein the condyle is completely removed and replaced with an artificial joint prosthesis in the context of bimax, has good evidence of stability.  I suspect (without evidence) that nobody in the UK follows Wolford's treatment philosophy.  Given the known risks of bimax relapse in the context of untreated TMJ pathology/disc displacement prior to surgery, I understand the hesitation to proceed.

[april]

I suspect (without evidence) that nobody in the UK follows Wolford's treatment philosophy.

From talking with other patients, TJR is pretty common in the UK actually.

[face_backward]

In that case, maybe OP should find somebody who does those to talk to -- presumably they'd have no problem doing a bimax in this context while also replacing the missing condyle.

[korvitz]

People relapse due to simply arthiritis of the TMJs let alone having part of their condyles missing from an condoylectomy, read A&G or Wolfords papers

how much of your condyle was entirely removed by the condoylectomy? Recently consulted with an surgeon whos well known on this board and was told an alternative to TJR could be transport distraction osteogenesis to create an new condyle, this way you stay natty & use your own bone which he says is preferable to an prosthetic https://www.semanticscholar.org/paper/Advances-in-temporomandibular-joint-reconstruction.-Ebrahimi-Ashford/f31a7b53ff82b1fe325687949762e42828d60f86/figure/0

[april]

Who was the surgeon? And has he ever performed it?

[korvitz]

Who was the surgeon? And has he ever performed it?

Albino Triaca told me that DO can be an alternative to TJR in patients with condyles that are missing, yes he has done it before though the case that I know of that Triaca did was not on an patient requiring orthognathic surgery with an history of condylar resorption or previously performed condyledectomy but it was on an young boy (about 8 years old) with an resected tumor so he not just missing an condyle but was literally missing 1/3rd of his mandible as well.

Although I do not need an TJR or DO on the condyles I am on an similar situation as Fowler and too am spooked about relapse (previous history of trauma which included bilaterally fracturing my condyles)

If you want more info PM me, though for your case I would suggest to just consult with an surgeon outside of Australia like Gunson as Gunson seems to have alot experience with condylar resorption

[april]

Albino Triaca told me that DO can be an alternative to TJR in patients with condyles that are missing, yes he has done it before though the case that I know of that Triaca did was not on an patient requiring orthognathic surgery with an history of condylar resorption or previously performed condyledectomy but it was on an young boy (about 8 years old) with an resected tumor so he not just missing an condyle but was literally missing 1/3rd of his mandible as well.

Although I do not need an TJR or DO on the condyles I am on an similar situation as Fowler and too am spooked about relapse (previous history of trauma which included bilaterally fracturing my condyles)

If you want more info PM me, though for your case I would suggest to just consult with an surgeon outside of Australia like Gunson as Gunson seems to have alot experience with condylar resorption

Interesting, I had a look at that paper's references and came across one by Relle & Schwartz from 2008. https://www.semanticscholar.org/paper/Distraction-osteogenesis-for-temporomandibular-Schwartz-Relle/4db71bb2283f1a932a5985db648a9bce857e51e7

I wonder if Relle still does transport DO...

Thanks for the info and referencing my case. I consulted with Gunson last month.