Treatment of hemimandibular hyperplasia: the biological basis of condylectomy.
ABSTRACT Treatments to correct skeletal deformities in patients with hemimandibular hyperplasia differ, particularly about the age at which the operation is done and the operation itself. To some extent, the differences can be attributed to the unknown biological basis of disease. The aim of the present study was to evaluate clinically the outcome of a rationale for the operation based on condylectomy on the affected side. Histological, radiological, and nuclear methods were used to get a more detailed insight into the reason for the operation. Six patients with hemimandibular hyperplasia were treated by a combined orthodontic-maxillofacial protocol. All patients had the affected joint removed. The histological morphology of each condylar specimen was compared with the bone scintigraphy to try and find a correlation between the methods. The clinical evaluation showed morphological and functional rehabilitation of all six patients. During the 2-year follow-up, all patients had stable symmetrical mandibles with no disturbance of temporomandibular function. Remodelling of the joint and the destruction of the cartilaginous layer was accompanied by much bone scintigraphic activity. We conclude that condylectomy can correct hemimandibular hyperplasia, even in patients with active condylar growth, by removing the underlying disease.
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ABSTRACT: INTRODUCTION: Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints METHODS: In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. RESULTS: No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. CONCLUSION: The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ.Head & Face Medicine 04/2013; 9(1):11. · 0.98 Impact Factor
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ABSTRACT: Condylar hyperplasia (CH) is a bone disease characterized by the increased development of one mandibular condyle. It regularly presents as an active growth with facial asymmetry generally without pain. Statistically it affects more women in adolescence, although it does not discriminate by age or gender. Its best-known consequence is asymmetric facial deformity (AFD), which combined with alteration of the dental occlusion with unilateral crossbite or open bite. It is not known when CH begins and how long it lasts; diagnostic examinations are described and are efficient in some research about diagnosis. Protocol treatment is not well studie and depends on the criteria described in this paper. The aim of this research is to provide up-to-date information about the diagnosis of this disease and to analyze the treatment protocol, visualizing the CH and AFD presented.International journal of clinical and experimental medicine 01/2013; 6(9):727-737.
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ABSTRACT: Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion.The Journal of craniofacial surgery 07/2013; 24(4):1451-1453. · 0.81 Impact Factor