Optimal Condylar Seating in Concurrent High Condylectomy and Sagittal Split Osteotomy

Unilateral condylar hyperplasia is characterized by progressive overgrowth of the mandibular condyle, often producing facial asymmetry, malocclusion, and temporomandibular joint (TMJ) dysfunction. Definitive management typically involves high condylectomy performed concurrently with orthognathic surgery. A key challenge is accurate seating of the neocondyle, which requires posterior, superior, and oblique repositioning within the glenoid fossa. The authors present a technical strategy utilizing a preauricular post-tragal incision with superficial musculoaponeurotic system (SMAS) flap elevation to expose the TMJ. Following high condylectomy, screws are placed at the glenoid fossa and lateral neocondyle, connected with a wire loop to gently traction the proximal segment up and posteriorly. This maneuver enables direct visualization and controlled seating of the neocondyle and disc. The technique is combined with bilateral sagittal split osteotomy and Le Fort I osteotomy, allowing intraoral fixation while maintaining condylar position. This approach enables single-stage correction of condylar hyperplasia and associated deformity, improving symmetry while reducing overall operative time. Direct visualization provides reliable condylar seating and may decrease the risk of malposition, joint dysfunction, and relapse.