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Nitzan DW. 'Adaptable condylectomy' for acquired facial asymmetry and malocclusion caused by temporomandibular joint condylar hyperplasia. Int J Oral Maxillofac Surg 2023; 52:1145-1155. [PMID: 37230928 DOI: 10.1016/j.ijom.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
This article describes the 'adaptable condylectomy' and highlights two innovative treatment protocols for the variety of acquired facial asymmetry and associated malocclusion caused by condylar hyperplasia, as illustrated by the cases of seven patients presenting different manifestations of condylar hyperplasia. Protocol I (three cases) is applied for condylar hyperplasia with a normal occlusion and involves a high condylectomy, with the goal of guiding the mandible back to the original occlusion. Protocol II (four cases) is applied for condylar hyperplasia with diverse acquired malocclusions and involves condylectomy at a level adapted to the malocclusion, allowing the mandible to be guided back to the occlusion that pre-existed the active change caused by the condylar hyperplasia, or to a position as close to the midline as possible. Both protocols are followed by gradual self-correction of the acquired facial asymmetry. These protocols often obviate the need for further surgical intervention and, if further correction is needed, it is much simpler.
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Affiliation(s)
- D W Nitzan
- Department of Oral and Maxillofacial Surgery, Hadassah School of Dental Medicine, The Hebrew University, Jerusalem, Israel.
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Espinosa S, Cortés R, Toro-Ibacache V. Single photon emission computed tomography (SPECT) diagnostic accuracy in active unilateral condylar hyperplasia: Retrospective study. J Craniomaxillofac Surg 2023; 51:467-474. [PMID: 37550116 DOI: 10.1016/j.jcms.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 05/30/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
The aim of this study was to assess the diagnostic accuracy of single photon emission tomography (SPECT) in unilateral condylar hyperplasia (UCH). To this end, 3D morphometric changes of the mandibles in one year were assessed (T0 vs. T1) and compared over SPECT results in T1, in a sample of 40 patients. A contingency table was constructed based on these results for SPECT diagnostic accuracy evaluation, classifying patients as SPECT true-positive, true-negatives, false positives and false-negatives. Additionally, the morphometric analysis was used to describe the presentation of mandibular changes using principal component analysis (PCA) and non-parametric statistics. We obtained diagnostic accuracy results of sensitivity 81%, specificity 63%, positive predictor value (PPV) 59%, negative predictor value (NPV) 83% and accuracy 70%, showing that SPECT yields poor results regarding accuracy diagnostic performance. The morphometric analysis showed that individuals without progress of asymmetry and those with more progress differ particularly in a group of landmarks representing the mental region and the right mandibular body. Based on these landmarks, difference among the four SPECT-accuracy groups was statistically significant (p < 0.001), where the landmark showing the largest change within a year had a mean increase of 1.13 + 0.66 mm. Within the limitations of the study, it seems that SPECT alone is not suitable for making surgical decisions regarding condylectomy in active UCH. Follow up with morphological assessment methods are recommended for confirming an active UCH in combination with SPECT.
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Affiliation(s)
- S Espinosa
- Department of Oral and Maxillofacial Surgery, Hospital Sótero del Río, Santiago, Chile; Department of Oral and Maxillofacial Surgery, Clinica Indisa, Santiago, Chile.
| | - R Cortés
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - V Toro-Ibacache
- Laboratory for Craniofacial Research and Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile; Department of Maxillofacial Surgery, Hospital Clínico San Borja Arriarán, Santiago, Chile
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Ouyang N, Zhang C, Xu F, Chen T, Shen G, Si J, Yu H. Evaluation of optimal single-photon emission computed tomography reference value and three-dimensional mandibular growth pattern in 54 Chinese unilateral condylar hyperplasia patients. Head Face Med 2023; 19:18. [PMID: 37202798 DOI: 10.1186/s13005-023-00365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/08/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The research aimed to evaluate the optimal Single-Photon Emission Computed Tomography (SPECT) cut-off value in differentiating condylar growth activeness, to observe 3-dimensional (3D) mandibular growth pattern, and to explore the potential correlation between 3D measurement parameters and SPECT uptake ratios in Chinese unilateral condylar hyperplasia (UCH) patients. METHODS Data of fifty-four Chinese UCH patients were analyzed retrospectively. All patients underwent SPECT within 1 month before or after the first CT examination (CT1); and received a second CT examination at least 12 months later (CT2). Data from CT scans were analyzed by comparing bilateral differences between CT1 and CT2. The sensitivity and specificity of SPECT were calculated by the receiver operating characteristic (ROC) curve. Pearson's correlation analysis was performed to investigate whether the mandibular growth was correlated with SPECT value. RESULTS SPECT had a sensitivity of 68.00% and a specificity of 72.41%, with an area under the ROC curve being 0.709. The optimal SPECT cut-off value for evaluating condylar activity has been determined to be 13%. In patients with an active growing condyle, there was a significant increase in Co-Gn and Co-Go, but not in Go-Gn, Go-MF, or MF-Gn. Pearson's correlation analysis revealed no correlation between 3D measurement parameters and differences in relative condylar uptake ratios. CONCLUSION SPECT showed good diagnostic performance in UCH with the cut-off value of 13%. For those with an active growing condyle, the mandible grows diagonally and vertically, while the relative condylar uptake ratio was not directly related to mandibular growth.
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Affiliation(s)
- Ningjuan Ouyang
- Department of Orthodontics, Shanghai Ninth People's Hospital, School of Medicine, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
| | - Chenglong Zhang
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
| | - Feng Xu
- Department of Nuclear Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Tiantian Chen
- Department of Oral Implantology, Shanghai Xuhui District Dental Center, Shanghai, 200031, China
| | - Guofang Shen
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
| | - Jiawen Si
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China.
| | - Hongbo Yu
- Department of Oral & Cranio-maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China.
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Lin Z, Xue Q, Lin R, Yao S, Miao W. Reference values of mandibular condylar growth activity: a study of SUVmax with quantitative bone SPECT/CT. Nucl Med Commun 2022; 43:152-158. [PMID: 34783720 DOI: 10.1097/mnm.0000000000001507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the condylar growth activity (CGA) with quantitative bone single photon emission computed tomography/computed tomography (SPECT/CT) to establish reference values of maximum standardized uptake value (SUVmax) and cutoff values for identifying active unilateral condylar hyperplasia (UCH) in different ages. METHODS We analyzed the CGA of 58 UCH patients and that of 125 volunteers as a control group by SUVmax of quantitative bone SPECT/CT imaging. The SUVmax and the uptake difference between bilateral condyles among different age groups were analyzed. SUVmax cutoff values for detecting active condyle were calculated by receiver operating characteristic curve analysis. RESULTS The condylar SUVmax in 10-19, 20-29, 30-39, 40-49 and 50-59 years old groups of volunteers were 6.24 ± 1.39, 4.76 ± 0.98, 3.23 ± 0.64, 3.00 ± 0.61 and 2.90 ± 0.53, respectively. The uptake difference between bilateral condyles in the control group was 3.84% ± 1.71%. The affected condylar SUVmax was significantly higher than that of the contralateral condyle in active UCH patients (6.03 ± 2.85 vs. 3.96 ± 1.07; Z = -5.264; P = 0.000). SUVmax of the affected condyles in active UCH patients was not statistically higher than condylar SUVmax in the corresponding age group (6.03 ± 2.85 vs. 5.50 ± 1.41; Z = -0.173; P = 0.863). SUVmax of the unaffected condyles was significantly lower than condylar SUVmax in the corresponding age group (3.96 ± 1.07 vs. 5.50 ± 1.41; Z = -5.833; P = 0.000). SUVmax cutoff values for identifying active condyle were 6.26 and 4.53 in patients of 13-19 and 20-29 years old, respectively. CONCLUSIONS The condylar SUVmax varied with age. Different cutoff values of condylar SUVmax should be employed for diagnosing active UCH for patients in different ages.
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Affiliation(s)
| | | | | | - Shaobo Yao
- Department of Nuclear Medicine
- Fujian Provincial Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Weibing Miao
- Department of Nuclear Medicine
- Fujian Provincial Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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López DF, Castro MA, Muñoz JM, Cárdenas-Perilla R. Reference values of mandibular condyles metabolic activity: A study using 99m Tc-MDP single-photon emission computed tomography. Orthod Craniofac Res 2020; 24:328-334. [PMID: 33090651 DOI: 10.1111/ocr.12434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the condylar bone metabolic activity in patients with temporomandibular joint health by measuring 99m Tc-MDP uptake using a single-photon emission computed tomography (SPECT) to establish reference values of the uptake difference between condyles and the ratio with respect to the clivus. SETTING AND SAMPLE POPULATION Eighty consecutive patients of both sexes who were admitted to a Nuclear Medicine Centre between 2017 and 2019 were included in the study. METHOD This was an observational cross-sectional study in patients with SPECT indications to evaluate pathologies other than those of the temporomandibular joint. The values of the total and normalized counts in a fixed region of interest of five trans-axial slides were obtained to assess the percentage difference between the sides and the uptake ratio. The reference values are expressed as median and 5th and 95th percentiles. RESULTS The sample included 53 women (66.25%) and 27 men (33.75%) aged 15-55 years. The percentage of uptake difference between condyles was 5.04% (0.46-14.78) for men and 5.17% (0.27-13.21) for women (difference not significant, P = .9). The uptake difference was below 10% in 85% of the subjects (n = 68). The ratio values for total counts in women (0.87, 0.46-1.33) were significantly different (P = .0030) from those in men (1.08, 0.61-2.09). No significant correlation with age was found. CONCLUSIONS These new reference ranges are applicable to the diagnosis of unilateral and bilateral condylar hyperplasia.
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Affiliation(s)
- Diego Fernando López
- Orthodontics Graduate Program, School of Dentistry, Universidad del Valle, Cali, Colombia
| | - María Angélica Castro
- Orthodontics Graduate Program, School of Dentistry, Universidad del Valle, Cali, Colombia
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