Osteochondroma of the condyle: case report with 15 years of follow-up

Factors Influencing Mandibular Deviation: A Retrospective Clinical Study

This study aimed to investigate the correlation between mandibular deviation (MD) and possible clinical factors in patients with anterior disc displacement (ADD). This retrospective clinical study enrolled 296 patients with ADD, diagnosed using magnetic resonance imaging, from 2015 to 2018. The clinical symptoms and medical histories of these patients were carefully examined and recorded. Mandibular deviation was the primary outcome variable confirmed by a combination of clinical examination and facial photographs or posteroanterior cephalograms. The primary predictor variable was ADD staging. Secondary predictor variables included condylar height and distance of disc displacement. Other predictor variables were age, sex, disease course, oral parafunctions, depression, and bone mineral density. We used logistic regression to examine the correlation between the MD and all predictor variables. The χ2 test and analysis of variance were used to exclude the correlation between the predictor variables. In this study, the prevalence of MD was 77% among 278 patients with ADD. Bilateral ADD staging significantly contributed to MD on both sides. The odds ratio increased with the deterioration of disc displacement. The present study demonstrated that the ADD staging influences the condylar height and MD, and that articular disk position should be considered while treating MD.

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.

Osteochondroma of the mandibular condyle: Indications for different surgical methods: A case series of 7 patients

The aim of this study was to evaluate and discuss the long-term outcomes of patients with condylar osteochondroma managed through 3 different surgical techniques. Seven patients with condylar osteochondroma treated in the author's department from May 2012 to January 2019 were included in this retrospective study. Clinical evaluations (visual analogue scale for TMJ pain, jaw function, symmetry, and quality of life), maximum interincisal opening (MIO) and radiological findings were collected pre- and postoperatively. Other parameters assessed included tumour size and location; complications and follow-up. Radical condylectomy with immediate total joint alloplastic reconstruction was performed in 4 patients, local excision in 2 patients and low condylectomy with concomitant orthognathic surgery in 1 patient. During an average follow-up period of 40,8 months no clinical or radiographic signs of recurrence were found. Average MIO increased from 25,5mm to 39,5mm at the longest follow up, and all clinical evaluations were greatly improved. In conclusion, the described surgical techniques appear valuable in the treatment of condylar osteochondroma. Local excision is indicated in tumor involving less than half the surface of the condylar head; radical condylectomy with immediate alloplastic total joint reconstruction is indicated in gigantic lesion compromising the anatomical components and function of the joint. Orthognathic surgery procedures should be combined with tumor resection when correction of associated dentofacial deformities is indicated.

A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma

Background

Mandibular condylar osteochondroma (OC) could lead to facial morphologic and functional disturbances, such as facial asymmetry, malocclusion, and temporomandibular joint dysfunction. However, after condylar OC resection, the inaccurate reposition of the neocondyle still needs to be solved. The purpose of this study was to explore the feasibility of the condylar osteotomy and repositioning guide to reposition the neocondyle in the treatment of patients with severe deformity secondary to condylar OC.

Results

Three patients with severe deformity secondary to OC of the mandibular condyle were enrolled in this study. With the aid of condylar osteotomy and repositioning guide, condylar OC resection and repositioning were carried out, and the accuracy and stability of these guides were evaluated. All patients healed uneventfully, and no facial nerve injury and condylar ankylosis occurred. Compared with the computerized tomography scans in centric relation before surgery and 3 days after surgery, the results showed that the facial symmetry was greatly improved in all the patients. Also, after the superimposition of the condylar segments before surgery and 3 days after surgery, the postoperative reconstructed condyles had a high degree of similarity to the reconstruction of the virtual surgical planning. Observed from the sagittal and coronal directions, the measurements of condylar positions were very close to those of virtual surgical planning. Moreover, it also showed stable results after a 1-year follow-up.

Conclusions

For patients with severe deformity secondary to condylar OC, condylar osteotomy, and repositioning guide was expected to provide a new option for the improvement of facial symmetry and occlusal relationship.

Recurrent osteochondroma of the mandibular condyle: A case report

A 21-year-old woman presented with facial asymmetry. Crepitus and clicking of the temporomandibular joint were noted. The midline deviated 5.5 mm to the left, and secondary malocclusion was observed. Panoramic and cone-beam computed tomographic images showed an irregular and exophytic bony mass on the anteromedial surface of the right mandibular condyle. A 3-phase bone scan revealed increased tracer uptake on the affected side. The lesion was treated with excision and reshaping under the diagnosis of osteochondroma confirmed by a histopathological examination. The lesion recurred after 3 years, and the patient underwent condylectomy. Mandibular condylar osteochondroma is often resected because it causes functional and aesthetic problems, but it rarely recurs. To the best of our knowledge, only 2 cases of recurrent osteochondromas of the mandibular condyle have been reported previously. Surgical treatment of the osteochondroma should be performed considering the possibility of recurrence, and long-term follow-up is recommended.