DESCRIPTION
A modified condylotomy is an open surgical procedure utilized for the treatment of temporomandibular joint (TMJ) disorders. It is classified as an extra-articular procedure because it is performed outside of the TMJ. The procedure is performed through the mouth, behind the molar teeth, so there are no incisions on the face. The condyle itself is not cut; thus the term condylotomy is a misnomer. The procedure creates a vertical cut in the mandible such that the region containing the mandibular condyle can be shifted downward and forward.
Because the extra-articular procedure is performed to alter the internal anatomy of the TMJ, not to change the condyle per se, a more accurate term for this repositioning osteotomy operation is indirect arthroplasty. The goals of the operation are to increase the joint space, to unload the joint while maintaining an unchanged occlusion and to decrease the pain and TMJ symptoms. In many cases a more normal disc/condyle relationship is achieved. Following the procedure, the individual must undergo maxillomandibular fixation wherein the jaw is wired in place for three to six weeks.
POLICY
A modified condylotomy for the treatment of temporomandibular joint (TMJ) disorders is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
See also: Orthognathic Surgery
MEDICAL APPROPRIATENESS
A modified condylotomy is considered medically appropriate if one or more of the following criteria (as demonstrated by history and clinical examination, x-ray, or imaging) are met:
Internal derangement (i.e., disc displacement) of the TMJ; or
Degenerative joint disease (e.g., osteoarthritis) of the TMJ; or
Recurrent luxation (re-seating of the ball in the socket when the TMJ pops out of place); or
Pain that is refractive to nonsurgical therapy (e.g., non-chew diet, intra-oral prosthetic devices/appliances, pharmacologic therapy); or
Is being performed to salvage a previously failed open intracapsular TMJ surgery.
ADDITIONAL INFORMATION
A modified condylotomy differs from orthognathic surgery, although both utilize mandibular ramus procedures. Orthognathic surgery is performed to correct malocclusion. A modified condylotomy procedure is a vertical osteotomy of the mandibular ramus designed to unload the TMJ and increase the TMJ space. Unlike orthognathic surgery, the goal of performing a modified condylotomy is neither to change the position of the mandible with respect to the maxilla nor to change the bite in any way.
SOURCES
American Society of Temporomandibular Joint Surgeons. (2001). Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Retrieved June 29, 2007 from http://www.astmjs.org/guidelines.html.
BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2003). Temporomandibular joint dysfunction (2.01.21). Retrieved June 5, 2007 from BlueWeb.
Choi, Y. S., Yun, K. I., & Kim, S. G. (2002). Long-term results of different condylotomy designs for the management of temporomandibular joint disorders. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 93 (2), 132-137. Abstract retrieved July 2, 2007 from PubMed database.
Complete Guide to Medicare Coverage Issues [Computer software]. (2007, April). Treatment of temporomandibular joint (TMJ) syndrome (Section 150.1, p. 4-214). St. Anthony Publishing.
Hall, H. D., Indresano, A. T., Kirk, W. S., & Dietrich, M. S. (2005). Prospective multicenter comparison of 4 temporomandibular joint operations. Journal of Oral and Maxillofacial Surgery, 63 (8), 1174-1179. Abstract retrieved July 2, 2007 from PubMed database.
Hall, H. D., Navarro, E. Z., & Gibbs, S. J. (2000). One- and three-year prospective outcome study of modified condylotomy for treatment of reducing disc displacement. Journal of Oral and Maxillofacial Surgery, 58 (1), 7-17.
Hall, H. D., Navarro, E. Z., & Gibbs, S. J. (2000). Prospective study of modified condylotomy for treatment of nonreducing disk displacement. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 89 (2), 147-158. Abstract retrieved July 2, 2007 from PubMed database.
Politi, M., Sembronio, S., Robiony, M., Costa, F., Toro, C., & Undt, G. (2007). High condylectomy and disc repositioning compared to arthroscopic lysis, lavage, and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 103 (1), 27-33. Abstract retrieved July 2, 2007 from PubMed database.
Werther, J. R., & Hall, H. D. (2000). Vertical ramus osteotomy and the inverted-L osteotomy. In R. J. Fonseca (Ed.), Oral and maxillofacial surgery: Orthognathic surgery (pp. 311-323). Philadelphia: W. B. Saunders Company.
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EFFECTIVE DATE |
7/26/2007 |
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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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