Surgical treatment of osteochondroma of the mandibular condyle in the adult

Condylar Osteochondroma: A Rare Case Report

Osteochondroma (OC) is an uncommon reason for the mandibular condyle to grow excessively. Usually unilateral, it can impact the entire mandible, the condyle and ramus, or just the condyle. It is a bony projection covered in cartilage that protrudes from the damaged bone's exterior. Condylar OC are more prevalent as a result of endochondral ossification-related development. The most notable characteristic is the gradual asymmetry of the face over time. Clinical symptoms of the patient include pain, asymmetry, malocclusion, partial or total hearing loss, trismus, and hypomobility of the TMJ. We report a case of 40-year-old male patient complaining of reduced mouth opening since last 10 years. Clinical examination revealed gross facial asymmetry, hard swelling over right TMJ, jaw deviation towards left side, restricted mouth opening of 3 mm and deranged occlusion. An irregular radiopaque mass was seen over the right condylar region in OPG. A large, hyperdense mass that obliterated the sigmoid notch and extended medially to the right condyle was visible on CT scans. Using a pre-auricular Alkayat-Bramley technique, the mass was surgically removed. Occlusal corrections and jaw physiotherapy were then administered. On follow up, deviation was corrected and adequate mouth opening was achieved.

Total Joint Replacement for Immediate Reconstruction following Ablative Surgery for Primary Tumors of the Temporo-Mandibular Joint

Temporomandibular joint (TMJ) tumors are rare and difficult to diagnose. The purpose of this retrospective study was to evaluate the clinicopathologic characteristics of twenty-one patients with primary TMJ tumors between 2010 and 2019 and to analyze the surgical outcome and morbidity after ablative surgery and TMJ replacement. This case series confirmed the difficulty of diagnosis and reaffirmed the need for early recognition and management of TMJ tumors. There were no pathognomonic findings associated with TMJ tumors, although single or multiple radiopaque or radiolucent areas were observed on plain or panoramic radiographs. Occasionally, bone resorption or mottled densities caused by pathologic calcification and ossification were seen. Computed tomography and magnetic resonance imaging played an important role in the diagnosis. In our study, the distribution of histologic types of TMJ tumors was quite different from that of other joint tumors. The recommended treatment was surgical intervention by ablation of the joint and TMJ replacement. The results of this retrospective study support the surgical exeresis and replacement with TMJ stock and custom-made prostheses and show that the approach is efficacious and safe, reduces pain and improves mandibular movements, with few complications.

Simultaneous Management of Condylar Osteochondroma and Secondary Malformation With a New Intraoral Approach

PURPOSE

The present study aimed to investigate the clinical efficacy of simultaneous management of condylar osteochondroma and its secondary dentofacial deformities using an intraoral surgical approach.

METHODS

Six patients with condylar osteochondroma were treated with intraoral vertical ramus osteotomies and condylar resection. The free rising branch was used for reconstructing the temporomandibular joint. The simultaneous orthognathic surgery and plastic surgery were performed sequentially to correct the secondary dentofacial deformities. The indexes of aesthetic symmetry, occlusion relationship, temporomandibular joint function, condylar height, and volume change were assessed in the subsequential follow up.

RESULTS

The mean follow up period was 31 months. All patients had no tumor recurrence. The ipsilateral joint function, occlusal relationship, and facial symmetry were satisfied. The ipsilateral condylar reconstruction had no obvious bone resorption and the ramus height was maintained well. Postoperative assessment showed the preoperative design was accurately fulfilled.

CONCLUSIONS

The simultaneous condylar osteochondroma resection and temporomandibular joint reconstruction using intraoral approach avoids extraoral scars and correct facial asymmetry without compromising the long-term joint function and occlusal relationship.

A simplified approach in the management of osteochondroma of the mandibular condyle

Osteochondroma of condyle is an exophytic lesion that arises from the cortex of bone and is capped with cartilage. It is one of the most common benign tumors of the bone. It usually appears in endochondral bones. In the mandible, it occurs most frequently at the condyle or coronoid processes. There has been ambiguity in understanding the nature of osteochondroma, whether it is neoplastic or just a reactive phenomenon. Here, we are presenting a case report of a 43-year-old male patient with a chief complaint of deviation of jaw toward the right side and progressive facial asymmetry for the past 1 year. There was an asymmetric prognathism of the lower jaw with ipsilateral open bite and contralateral crossbite. The patient was planned for surgery under general anesthesia. The tumor was dissected from its soft-tissue attachments, and then, complete excision of the tumor was done. Histopathological examination of the lesion showed a proliferation of bony and hyalinized cartilage-like tissues. Two-year postoperative follow-up was uneventful, and no second surgical intervention was required. Computed tomography scan after 2-year follow-up revealed no reoccurrence of lesion, and the patient's facial profile was significantly improved.

Effect of condylar osteochondroma resection through an intraoral approach on the masticatory functions: a preliminary evaluation based on occlusion and temporomandibular joint functions

With this research, we aimed to evaluate the effect of condylar osteochondroma (OC) resection through an intraoral approach on the masticatory functions. Resection of condylar OC was carried out via an intraoral approach with the help of three-dimensional (3D) design, endoscope, and navigation system. The T-Scan III computerised occlusal analysis system was used to evaluate the occlusal force distribution, recorded at pre-treatment (T1) and post-treatment (T2) intervals. Records of the clinical examination of the temporomandibular joint (TMJ), including maximal interincisal opening, mandibular lateral and forward movements, were also collected. Ten patients with condylar OC were enrolled in this study. The difference of force distribution between bilateral occlusion was reduced in T2 compared with T1 (11.92% ± 4.41% vs 48.52 % ± 28.37%, p<0.05), indicating better occlusal force distribution obtained after surgery. There was no significant difference in functions of the TMJ, such as maximal interincisal opening, and mandibular lateral and forward movements between T2 and T1 (p>0.05). Accordingly, condylar OC resection through an intraoral approach would obtain a satisfactory occlusal balance with no impairment of the temporomandibular joint functions.

Digital cutting guide and endoscopically-assisted vertical ramus osteotomy to treat condylar osteochondroma: a long-term study

We have introduced an effective treatment for mandibular condylar osteochondroma with a digital cutting guide and endoscopically-assisted vertical ramus osteotomy (VRO). Eleven patients with unilateral condylar osteochondroma, who did not require orthognathic surgery or had less than 3mm deviation of the chin and a stable occlusion, were treated during the period April 2013-January 2017 with a digital cutting guide and endoscopically-assisted VRO. Clinical data collected included the occlusion, facial contour, and maximum mouth opening (MMO). Computed tomographic (CT) scans were taken before and after operation. Two patients also had additional shaping of the mandibular contour. The pathological diagnosis was confirmed to be osteochondroma in all cases. A mean (range) 19 (12-40) months of follow-up for all 11 cases showed stable postoperative occlusion and facial aesthetics. There were no functional disturbances, recurrence, or condylar absorption. VRO is an alternative to orthognathic surgery for patients with osteochondroma who do not have severe malocclusions. The digital cutting guide and endoscopically-assisted VRO make it possible to achieve precise resection of the tumour and maintain the occlusion with minimal invasion.

An unusually large osteochondroma of the mandibular angle: a case report

BACKGROUND

Osteochondroma is a benign bone tumor that can occur in both the mesenchymal and craniofacial bones. However, craniofacial osteochondromas are extremely rare, because the mandible develops by intramembranous ossification rather than by endochondral ossification.

CASE PRESENTATION

The most common site of craniofacial osteochondroma is the mandibular condyle, followed by the coronoid process. In the present study, we have described the case of a 64-year-old Japanese man with an unusually large osteochondroma located on the internal angle of the mandibular body. Clinical, radiological, pathological, and treatment-related aspects are discussed with respect to the tumor origins.

CONCLUSIONS

In the medical literature, there have been few reports of large osteochondromas of the mandibular angle with no clinical symptoms.

Surgical excision of osteochondroma on mandibular condyle via preauricular approach with zygomatic arch osteotomy

Background

Osteochondroma is a benign tumor that tends to develop in mandibular condyle and coronoid process in the craniofacial region. If tumor mass has grown from condyle into the infratemporal space with zygomatic arch obstructing the access, there are risks associated with surgical exposure and local resection of these masses.

Case presentation

This study reports on a case of osteochondroma on mandibular condylar head where we treated with surgical excision via preauricular approach with 3D analysis. After the local resection, there were no surgical and post-operative complications until 8-month follow-up period.

Conclusions

In local excision of osteochondroma, our method is a minimally invasive method. It is a good example of osteochondroma treatment.

From ideal occlusion to dentofacial deformity and back to ideal: an osteochondroma treatment with lingual orthodontics

This original case report describes the morphologic changes caused by a mandibular condylar osteochondroma (OC) on a female patient and its treatment. The changes were identified by comparing her final records from a previous orthodontic treatment, without the presence of OC, to records taken before a second treatment, with a developed OC. The diagnostics and treatment for the OC and its consequences were described and discussed in this paper. Treatment included orthodontics with a lingual appliance, low condylectomy on the affected side, high condylectomy on the contralateral side, bilateral disc repositioning and orthognathic surgery. It was concluded that the OC caused a Class III subdivision malocclusion, midline deviation and an edge-to-edge bite on the left side, a cant of the occlusal plane on the Z-axis and a deviation of the pogonion to the left. Treatment was successful and stable long term (36 months) with good occlusal, aesthetical and functional results.

Dentofacial Deformity Caused by Bulky Osteochondroma: Report of an Unusual Case and the Importance of Cone Beam Computed Tomography

INTRODUCTION

Osteochondroma of mandibular condyle is a rare benign tumor.

CASE REPORT

This case report described clinical, radiographic features, differential diagnosis, histopathologic correlation and treatment of condylar osteochondroma.

CONCLUSION

Conebeam computed tomography (CBCT) is an alternative modality to CT or MRI that should be performed in all cases of suspected osteochondroma of the mandibular condyle.

Conservative condylectomy alone for the correction of mandibular asymmetry caused by osteochondroma of the mandibular condyle: a report of five cases

We describe our experience with conservative condylectomy for the correction of facial asymmetry in five patients with osteochondroma of the mandibular condyle. All five patients presented with malocclusion and facial asymmetry, which are common clinical findings of osteochondroma involving the mandibular condyle. We performed conservative condylectomy without additional orthognathic surgery for all five patients, preserving the vertical height of the condylar process as much as possible. Following surgery, intermaxillary traction using a skeletal anchorage system with rubber elastics was performed on all patients to improve occlusion, and, when necessary, additional minimal orthodontic treatment was performed. The mean follow-up period was 42 months. At the last follow-up visit, all patients exhibited satisfactory facial symmetry and remodeling of the remaining condyle, with stable health and no signs of recurrence. In conclusion, conservative condylectomy alone, without subsequent orthognathic surgery, is adequate for the restoration of facial symmetry and the preservation of vertical condylar height in select patients with condylar osteochondroma.

Osteochondroma of the mandibular condyle - Report of an atypical case and the importance of computed tomography

Osteochondroma is a rare tumor of the mandibular condyle. Much confusion seems to exist in the literature in differentiating these tumors from chondromas as well as condylar hyperplasias. Due to considerable overlapping features between chondromas and condylar hyperplasia, it is likely to get misdiagnosed, thereby resulting in inadvertent errors in the treatment. A case report of a 35 year old male patient with mandibular deviation and malocclusion is presented here. He initially went unnoticed for features of an osteochondroma of the mandibular condyle but was subsequently treated for the same.

Condylar osteochondroma treated with total condylectomy and preservation of the articular disc: a case report

Osteochondroma is frequently found in the general skeleton but is rare in the condylar region of the mandible. We report a case of an osteochondroma of large size and rapid growth in the mandibular condyle, which was treated with total condylectomy and condylar replacement with a costochondral graft and preservation of the articular disc. In cases with a healthy and well-positioned articular disc, it may be preserved with no need of disc repositioning.

Computer-assisted surgical planning and intraoperative navigation in the treatment of condylar osteochondroma

Mandibular condylar osteochondroma (OC) results in asymmetric prognathism with facial morphology and functional disturbances. The aim of this study was to explore the feasibility of computer-assisted surgical planning combined with intraoperative navigation in the treatment of condylar OC. Five patients with mandibular condylar OC were enrolled in this study. Surgical planning and simulation was performed based on a computed tomography reconstruction model using SurgiCase software. Under the guidance of navigation, a condylar OC resection and conservative condylectomy was carried out via intraoral approach. Simultaneous orthognathic surgery was used to correct the facial asymmetry and malocclusion. All patients healed uneventfully. No facial nerve injury or salivary fistula occurred. Facial symmetry and morphology were greatly improved and stable occlusion was obtained in all cases. Good matching between preoperative planning and postoperative results was achieved. Patients showed no signs of recurrence or temporomandibular joint ankylosis during follow-up of 12-30 months. Computer-assisted surgical planning and intraoperative navigation is a valuable option in the treatment of mandibular condylar OC.

Osteochondroma of the palate: An interesting and an unusual case presentation

A 40-year-old Indian male patient was referred to the Department of Oral and Maxillofacial Surgery with a slowly enlarging intra-oral, right-sided palatal swelling of one-year duration, with a previous diagnosis of osteochondroma. Extraorally, patient presented with a mild right-sided facial swelling. On intraoral examination, the palatal swelling was extending from the distal aspect of canine to the distal aspect of second molar with involvement of the maxillary tuberosity. The swelling was non-tender, bony-hard in consistency and covered by normal mucosa. The medical history was non-contributory with no relevant family history of any skeletal disease. Despite the attempt for complete removal of the tumor previously, it recurred within six months. The present article reports an extremely rare clinical case of endosteal (central) osteochondroma, manifesting itself as a radiopaque mass in the right posterior aspect of the palate.

Osteochondroma of the glenoid fossa--report of two cases with sudden onset of symptoms

Osteochondroma of the temporomandibular joint is a rare condition that most frequently affects the mandibular condyle. Fixed osteochondroma originating from the glenoid fossa is extremely rare and a literature search identified only two reported cases. The cases of two additional patients in whom osteochondroma developed in the posterior part of the glenoid fossa leading to the sudden onset of chin deviation and malocclusion are reported herein. We conclude that osteochondroma of the glenoid fossa is a slow growing benign tumour with typical clinical and radiological features. It requires surgical treatment, comprising resection of the tumour. Recurrence appears unlikely.

Jaw deviation and ankylosis caused by condylar osteochondroma: long-term treatment outcome

PURPOSE

To evaluate outcomes of total subcondylar excision of mandibular condylar osteochondroma.

PATIENTS AND METHODS

Two adult patients presented with progressive facial asymmetry, jaw deviation, and limited mouth opening. Computed tomogram (CT) showed a large osseous tumor arising from the right condyle occupying the subtemporal space in these patients. Complete surgical excision was performed without condyle reconstruction. The pathology report indicated osteochondroma. Patients were followed for an average of 5 years.

RESULTS

Long-term evaluation showed restoration of dento-occlusal function and facial appearance. Follow-up CT showed a partly regenerated and remodeled condyle. Patients' chewing function was acceptable, but predominantly on the lesion side.

CONCLUSIONS

Condylar osteochondroma caused jaw deviation and joint dysfunction. Complete surgical excision achieved an adequate long-term outcome, but condylar reconstruction is advisable.

Osteochondroma of condyle: case discussion and review of treatment modalities

Temporomandibular joint (TMJ) forms a synovial articulation between the condyle and the cranium. It is a complex joint and shows hinge and gliding movements. Unlike other articulating heads, condyle grows with intramembranous ossification. TMJ is subjected to excessive loads throughout life as it supports essential functions such as mastication, deglutition, speech and respiration. Traumatic, neoplastic or non-neoplastic pathologies sometimes necessitate joint replacement therapy. Osteochondroma is one such benign tumour originating from condyle which requires surgical replacement of condyle with prosthesis. Various replacement methods have been designed in the past. Alloplastic grafts have been successfully used in joint replacement surgeries like hip joint, knee joint, etc. This case discussion supports the use of titanium-made condylar prosthesis for long-term functional stability of TMJ.

Endoscope-assisted conservative condylectomy in the treatment of condylar osteochondroma through an intraoral approach

Mandibular condylar osteochondroma (OC) can result in morphological and functional disturbances, including facial asymmetry and temporomandibular joint (TMJ) dysfunction. The aim of this study was to explore the feasibility of endoscope-assisted tumour resection and conservative condylectomy via an intraoral approach. Seven patients with condylar OC were enrolled in this study. Endoscope-assisted tumour resection and conservative condylectomy were achieved intraorally, and no conventional extraoral incision was needed. Direct vision of the magnified and illuminated operative field was realized with the assistance of an endoscope. No facial nerve injury or salivary fistula occurred in any patient. Stable occlusion was realized through postoperative orthodontic treatment. The patients showed no signs of tumour recurrence or TMJ ankylosis during follow-up (range 18-43 months). Endoscope-assisted condylar OC resection and conservative condylectomy via intraoral approach offers great advantages with no significant complications compared with conventional extraoral incisions. The endoscope provides us with a valuable treatment option for this potentially complicated procedure.

Osteochondroma of the temporomandibular joint: report of 2 cases emphasizing the importance of personalizing the surgical treatment

BACKGROUND

Osteochondromas (OCs) are rare in the craneofacial area (0.6%). We present 2 cases of OC of the mandibular condyle, emphasizing the surgical decision of each case. CASE 1: In a 48-year-old woman with facial asymmetry, left cross-bite, and mandible deviation to the left, a computerized tomographic (CT) scan confirmed the presence of a bony expansion of the right condyle. The clinical diagnosis was osteochondroma. The patient underwent condylectomy with costochondral reconstruction. CASE 2: In a 76-year-old woman with a 1-month history of right preauricular pain, CT showed a deformed right condyle with a bony mass at the base of the temporal bone and the articular fossa. OC of the skull base was diagnosed, with possibly a concurrent lesion of the condyle. The patient underwent condylectomy with the removal of the skull base mass and an inmediate TMJ reconstruction by means of an appropriately sized stock total TMJ prosthesis.

CONCLUSIONS

It is necessary to personalize the temporomandibular joint reconstructive options.

Endosteal (central) osteochondroma of the mandibular body

Cartilaginous pathology of the jaws is relatively uncommon, owing the fact that the osteochondroma of the mandibular body are extremely rare. This paper elaborates on the rare case of endosteal (central) osteochondroma created 6 months after exodontia in the left body of the mandibula in tooth region #36. After obtaining a histologic diagnosis of an osteochondroma, a tumor was locally resected. One year later, panoramic radiographs showed bone regeneration at the site of the previously resected osteochondroma. However, extreme caution should be maintained, because an osteochondroma could be the first feature of osteosarcoma or chondrosarcoma. Therefore, regular clinical examinations and radiographic evaluations are mandatory every 6 and 12 months, respectively.

Osteochondroma of the temporomandibular joint: a case report

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Osteochondromas of the mandibular condyle: variance in radiographic appearance on panoramic radiographs

OBJECTIVES

Osteochondromas are frequently found in the general skeleton, but are rare in the mandibular condyle. Radiographically, most reports describe osteochondromas as a mushroom-shaped bony enlargement capped with cartilage on the condylar surface. However, the radiographic appearance of this lesion on the panoramic radiograph has rarely been studied. The purpose of this article is to increase the radiographic knowledge of mandibular condylar osteochondroma and facilitate making an exact diagnosis through observing the lesional appearance on panoramic radiograph.

METHODS

The panoramic radiographs of 12 cases of mandibular condylar osteochondromas were reviewed. All cases were obtained from the Department of Oral Radiology, West China College of Stomatology, Sichuan University, between 1988 and 2006. The final diagnoses of all cases were based on pathology.

RESULTS

Osteochondromas may arise on different areas around the mandibular condyle and present diverse appearances on panoramic radiograph.

CONCLUSIONS

The mandibular condylar osteochondromas may show different growth positions encircling the condyle and exhibit varying shapes on panoramic radiograph. These features will help us to increase cognition of the lesion and make an exact diagnosis.

Osteochondroma of the glenoid fossa—A case report

Osteochondroma of the facial skeleton is a rare tumour that is usually managed by maxillofacial surgeons. In countries where this service is not available, or is provided by inexperienced surgeons, the management is difficult. We describe a case of osteochondroma of the glenoid fossa that was managed by surgeons with experience in temporomandibular surgery.

Osteochondroma of the mandible causing severe facial asymmetry: A case report

Osteochondroma is one of the most common benign tumors of bone. Although osteochondroma is rarely seen in facial region, the cases in literature are usually in the mandibular region, especially around the condyle. The treatments of these lesions include total condylectomy or local resection of the lesion. The aim of the present study is to emphasize the importance of stereolithographic models in planning tumor surgery and how it affects the treatment planning, operation time and prognosis. In this report, the patient had an osteochondroma in the left condylar region, pushing the condyle seriously to the anterior. The clinical findings were 8 mm deviation of midline to the right side, 23 mm mouth opening, unilateral posterior cross-bite on the right side, and 8 mm negative horizontal overjet. We acquired a 3-dimensional solid model of the patient. Determination of the anatomy of the surgical area, determination of the surgical access method, and other treatment planning were all done on the stereolithographic model. Based on the model evaluation, the tumor was conservatively resected and the condyle left intact, leaving no sequelae. All the preoperative problems were resolved except the midline deviation.