Authors of section

Author

Boaz Arzi

Executive Editor

Amy Kapatkin

General Editor

Frank Verstraete

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Condylectomy

1. Principles

Decision making on treatment of TMJ fractures is complex. It should be based on anatomical site, patient size and age, fracture configuration and desired function. CT imaging is essential. Skull or dental radiographs are not adequate to assess the extent of TMJ fractures.

Evidence-based approach to TMJ fractures in dogs and cats is lacking. The treatments recommended here are based on clinical experience of veterinary and human CMF surgeons.

CT of a dog mandible with TMJ fracture

Restoring functionality and range of motion as well as maintaining occlusion are the primary goals of TMJ fracture treatments.

Condylectomy is a salvage procedure that may result in postoperative malocclusion.

condylectomy

2. Approach

The patient is placed in lateral recumbency. A lateral approach to the TMJ is performed at the ventral aspect of the zygomatic arch.

condylectomy

3. Technique

Ostectomy of the condylar process

An ostectomy is performed at the level of the neck of the condylar process.

A piezosurgery technique is preferred because soft tissue is preserved while cutting bone.

condylectomy

Alternatively, a surgical hand piece with a bone bur and/or an osteotome can be used. Small fragments can be removed with a rongeur.

Note: Care should be taken to avoid damaging the maxillary artery that lies medial to the TMJ to avoid severe bleeding.

condylectomy

Osteoplasty

The edges of the osteotomy should be finished using a round diamond bur on a surgical hand piece.

condylectomy

4. Closure

The joint capsule is closed with poliglecaprone 25 or another monofilament absorbable suture.

The masseteric fascia is attached to the periosteum of the zygomatic arch. The platysma and subcutaneous tissue are closed as one layer, followed by the skin.

5. Aftercare

Multimodal analgesia is recommended. Non-steroidal medication for 10-14 days and opioids for the first 5 days post-surgery as needed.

Antibiotic therapy is prescribed for a period of 10-14 days following surgery.

The use of large kibble is encouraged immediately after surgery to promote active rehabilitation of the jaw. Suture removal is performed 10-14 days after surgery.