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Wang L, Wang Y, Sun X, Chen K, Pang W, Gao Y, Zhu Z, Wu G. A Novel Technique for Resection and Reconstruction of the Temporomandibular Joint by Sliding Vertical Ramus Osteotomy using Only Submandibular Approach. J Craniofac Surg 2023; 34:2163-2167. [PMID: 37291710 DOI: 10.1097/scs.0000000000009408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/19/2023] [Indexed: 06/10/2023] Open
Abstract
In this paper, an innovative technique for resection and reconstruction of the temporomandibular joint by sliding vertical ramus osteotomy using only a submandibular approach is presented. Before pulling the posterior mandibular border slightly downward to expose parts of the condyle, the vertical ramus osteotomy was performed. With the help of 3D simulation and surgical templates, the condylectomy was carried out using the ultrasonic osteotome through the submandibular approach. Our technique achieved the desired results while preventing complications of facial nerve paralysis, the occurrence of Frey syndrome, and the preauricular scar. Therefore, we suggest that this surgical method represents an alternative treatment option for temporomandibular joint lesions.
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Affiliation(s)
- Lin Wang
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Yingtong Wang
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Xiumei Sun
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Kai Chen
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Wanyu Pang
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Yisu Gao
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Zihe Zhu
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
| | - Guomin Wu
- Department of Oral, Plastic and Esthetic Surgery, Hospital of Stomatology, Jilin University, No.1500 Qinghua Road, Changchun, Jilin, China
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Emmerling MR, LaVigne M, Warburton G, Caccamese JF, Ord RA. Extracorporealization of the Mandibular Condyle: Effects on Viability and Function. Craniomaxillofac Trauma Reconstr 2023; 16:130-137. [PMID: 37222979 PMCID: PMC10201190 DOI: 10.1177/19433875221095989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we conducted a retrospective analysis of surgical outcomes. Objective For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we investigated the viability of this technique through a retrospective analysis of outcomes. Methods Twenty-six patients were treated using EVRO with extracorporealization of the condyle for both condylar fractures (18 patients) and osteochondroma (8 patients). Of the 18 trauma patients, 4 were excluded due to limited follow-up. Clinical outcomes were measured, including occlusion, maximum interincisal opening (MIO), facial asymmetry, incidence of infection, and temporomandibular joint (TMJ) pain. Radiographic signs of condylar resorption were investigated, quantified, and categorized using panoramic imaging. Results Average follow-up was 15.9 months. Average maximum interincisal opening was 36.8 mm. Four patients demonstrated mild resorption and one patient demonstrated moderate resorption. Two cases of malocclusion were attributed to failed repairs of other concurrent facial fractures. Three patients reported TMJ pain. Conclusions Extracorporealization of the condylar segment with EVRO to facilitate open treatment of condylar fractures is a viable treatment option when more conventional approaches prove unsuccessful.
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Affiliation(s)
- Max R. Emmerling
- Division of Oral and Maxillofacial
Surgery, Cook County Health, Chicago, IL, USA
| | - Meghan LaVigne
- Department of Oral and
Maxillofacial Surgery, University of Maryland Medical
Center, Baltimore, MD, USA
| | - Gary Warburton
- Department of Oral and
Maxillofacial Surgery, University of Maryland
Baltimore, Baltimore, MD, USA
| | - John F. Caccamese
- Department of Oral and
Maxillofacial Surgery, University of Maryland
Baltimore, Baltimore, MD, USA
| | - Robert A. Ord
- Department of Oral and
Maxillofacial Surgery, University of Maryland
Baltimore, Baltimore, MD, USA
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Anderson SR, Pak KY, Vincent AG, Ong A, Ducic Y. Reconstruction of the Mandibular Condyle. Facial Plast Surg 2021; 37:728-734. [PMID: 33878796 DOI: 10.1055/s-0041-1726444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.
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Affiliation(s)
- Spencer R Anderson
- Department of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Kaitlynne Y Pak
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | | | - Adrian Ong
- Facial Plastic Surgery Associates, Fort Worth, Texas
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Gupta M, Sen S. Analysis for different functional results of TMJ ankylosis management by comparing ramus-condyle unit reconstruction using vertical ramus osteotomy and interpositional gap arthroplasty. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:10-17. [PMID: 33744205 DOI: 10.1016/j.oooo.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the present study was to analyze the functional results of temporomandibular joint (TMJ) range; that is, trismus index, lateral excursion, protrusion, retrusion, occlusion, masticatory efficiency), reestablishment of the anatomic relationship of the TMJ, aesthetics to improve quality of life, and complications in terms of ramus shortening on the affected side, deviation, facial asymmetry, neurologic deficits, and reankylosis. STUDY DESIGN Sixteen patients with unilateral bony ankylosis were included and randomly divided into 2 groups with 8 patients in each group. Group I was treated with interpositional gap arthroplasty followed by reconstruction of the ramus-condyle unit using vertical ramus osteotomy. Group II was treated with interpositional gap arthroplasty. In both groups, a pedicled flap made up of fascia, temporalis muscle, and pericranium was used as an interpositional material. The functional range of the mandible was analyzed pre- and postoperatively. RESULTS Group I improved significantly more than group II in terms of TMJ range; that is, trismus index, lateral excursion, protrusion, retrusion, reestablishment of the normal anatomic relationship of the TMJ, aesthetics, and masticatory efficiency. The reestablishment of anatomic relationship showed better result in mastication significantly. No reankylosis was reported in any of the groups. CONCLUSION The functional results and aesthetics with TMJ reconstruction are significantly better.
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Affiliation(s)
- Monika Gupta
- Professor, Maharishi Markandeshwar College of Dental Sciences & Research, Mullana, Ambala, Haryana, India.
| | - Sourav Sen
- Professor, Maharishi Markandeshwar College of Dental Sciences & Research, Mullana, Ambala, Haryana, India
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Ramanathan M, Kiruba GA, Christabel A, Parameswaran A, Kapoor S, Sailer HF. Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes. J Maxillofac Oral Surg 2020; 19:477-489. [PMID: 33071493 DOI: 10.1007/s12663-020-01414-y] [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: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction The popularity and interest evoked by orthognathic surgery and distraction osteogenesis are undisputed in the field of oral and maxillofacial surgery. However, questions regarding the individual identities of either of them with clarity in their concepts, techniques and outcomes have remained unanswered. The aim of this review is to shed light on these questions. Methods This review is structured as a narrative review of thirty years of literature available in the specialities of orthognathic surgery and distraction osteogenesis. Conclusion The authors present a review of existing literature combined with contrasting experience gained over the years in providing an overview of the merits and demerits of the two surgical techniques which will aid the clinician in justifying the use of one technique over the other.
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Affiliation(s)
- Manikandhan Ramanathan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | - Godwin Alex Kiruba
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | | | | | - Sanjanaa Kapoor
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, India
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Pandyan DA, Maheedhar AV, Giri GVV, Kumar KS. Wilkes Stage IV Internal Derangement-An Osteochondromatosis of Condyle. Ann Maxillofac Surg 2020; 9:478-480. [PMID: 31909040 PMCID: PMC6933980 DOI: 10.4103/ams.ams_27_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteochondroma (OC) or osteocartilaginous exostosis is characterized by cartilage capped, osseous projection protruding from the surface of affected bone. OC is the most common tumor of skeletal bones. This benign tumor can occur as a part of autosomal dominant syndrome called osteochondromatosis. Here, we describe a case report with our view in managing the patient and giving best treatment with the help of knowledge gained by literature and experience.
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Affiliation(s)
- Deepak A Pandyan
- Department of Oral and Maxillofacial Surgery, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | | | - G V V Giri
- Department of Oral and Maxillofacial Surgery, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - K Santosh Kumar
- Department of Oral and Maxillofacial Surgery, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Treatment of hemimandibular hyperplasia by computer-aided design and computer-aided manufacturing cutting and drilling guides accompanied with pre-bent titanium plates. J Craniomaxillofac Surg 2020; 48:1-8. [DOI: 10.1016/j.jcms.2019.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/16/2019] [Accepted: 01/25/2019] [Indexed: 11/20/2022] Open
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Khanna JN, Ramaswami R. Protocol for the management of ankylosis of the temporomandibular joint. Br J Oral Maxillofac Surg 2019; 57:1113-1118. [PMID: 31732273 DOI: 10.1016/j.bjoms.2019.10.298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
Ankylosis of the temporomandibular joint (TMJ) is a severely deforming, disabling condition as a result of craniomandibular fusion caused mainly by condylar fractures with displacement of the meniscus. Ankylosis may be fibrous, fibro-osseous, or bony, and unilateral or bilateral. The severity of the deformity is based on the onset, duration, and type of ankylosis. Various surgical techniques have been described for treatment, but no single treatment is recommended because of inconsistent results and the high rate of failure. While our total experience extends to 300 cases, we have developed a protocol using the most recent 193 patients to address our earlier high failure rate. The onset was during childhood in 168 patients, and 25 were adults. We describe the protocol that we developed for these two groups. Our management included gap arthroplasty, costochondral grafting, temporalis flaps, ramus osteotomies, and transport distraction.
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Affiliation(s)
- J N Khanna
- Saifee Hospital, Mumbai, Maharashtra, India
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Heffez LB. The Inverted Coronoid-Ramus Graft for Condylar Reconstruction. J Oral Maxillofac Surg 2019; 77:1315.e1-1315.e19. [PMID: 30926545 DOI: 10.1016/j.joms.2019.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/19/2022]
Abstract
The purpose of this article is to describe a creative, versatile technique for condylar reconstruction using autogenous mandibular bone. The technique has been used for reconstruction of small condyle and/or ramus defects (approximately 35 to 40 mm in length) typically associated with condylar hyperplasia, condylar tumors, idiopathic condylar resorption, and failed reconstruction attempts. The technique involves excision of the ipsilateral coronoid process-mandibular ramus, inverting it and rotating the segment 180° along its horizontal axis to replace the excised condyle. The resultant graft simulates the morphology of the posterior aspects of the ramus and condyle and has been shown to resist resorption typical of endochondral bone grafts harvested from the rib or iliac crest. Grafting is carried out via vestibular and preauricular or endaural incisions. Four cases followed over a period of 3 to 40 months (average, 21 months) are presented. No adverse functional results, including ankylosis, removal of hardware or adverse remodeling, have occurred. A period of intermaxillary fixation is used because it is considered beneficial for intra-articular scarring of the subglenoid fossa pad (disc or retrodiscal tissue and fibrocartilage) and initial healing. Physical therapy has not been prescribed. The inverted coronoid graft is a versatile technique when virtual surgical planning is used to assess feasibility, as well as defect and graft dimensions; fabricate custom bone plate and drilling guides; and determine screw osteosynthesis sites. In general terms, a post-reconstruction opening of 35 mm allows for adequate function and guards from contralateral symptomatic hypermobility given disparate right- and left-sided joint mechanics. In the cases described, a mean of 40.5 mm was achieved; however, in 2 of these cases, this was measured with undesirable asymptomatic (preoperative) deviation to the ipsilateral side by greater than 4 mm and by 6 mm. The inverted coronoid graft technique reduces operative time, can be executed with few external scars, and reduces the number of operative fields.
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Affiliation(s)
- Leslie B Heffez
- Attending, Private Practice, Oral & Maxillofacial Surgery, Highland Park and Chicago, IL; NorthShore University Hospital; and Former Professor and Head, University of Illinois at Chicago, Chicago, IL.
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Zhou Z, Zhao H, Zhang S, Zheng J, Yang C. Evaluation of accuracy and sensory outcomes of mandibular reconstruction using computer-assisted surgical simulation. J Craniomaxillofac Surg 2018; 47:6-14. [PMID: 30471936 DOI: 10.1016/j.jcms.2018.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/27/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To introduce a modified protocol for mandibular reconstruction and evaluate the protocol using a standardized assessment method. METHOD This retrospective study involved a case series of nine patients who underwent mandibular reconstruction between 2015 and 2017. The modular protocol comprised three novel modifications in terms of computer-assisted surgical simulation (CASS); surgical template (ST), and surgical procedure. The standardized postoperative evaluation consisted of operation time, part comparison analysis (PCA), facial symmetry, and mechanical quantitative sensory testing. RESULTS The surgery successfully removed the affected mandible and preserved the inferior alveolar neurovascular bundle (IANB). PCA revealed that the mean error and standard deviation were 0.92 and 0.96 mm, respectively, for all mandibular surface sites. Follow-up results showed good facial symmetry, existence of sensation in lower lip, and no significant differences in pulp vitality between both sides (p = 0.181). Also, the results showed a reduction in the overall operating time. CONCLUSION The modified mandibular reconstruction method used in this study could repair lateral mandibular defects and preserve the sensory function of the chin and lower lip.
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Affiliation(s)
- Zhihang Zhou
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Haoming Zhao
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shanyong Zhang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Jisi Zheng
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Chi Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Collage of Stomatology, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Zhou H, Liao C, Hu J, Fei W. Comparison of the clinical effects of treatment of osteochondroma by two types of vertical ramus osteotomy. Br J Oral Maxillofac Surg 2018; 56:19-23. [DOI: 10.1016/j.bjoms.2016.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
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Guideline for the Treatment of Condylar Osteochondroma Combined With Secondary Dentofacial Deformities. J Craniofac Surg 2017; 27:1156-61. [PMID: 27258707 DOI: 10.1097/scs.0000000000002471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Surgical treatment of condylar osteochondroma combined with secondary dentofacial deformities is a significant clinical challenge. The authors present this review article to provide some guidelines for the surgical treatment for this severely complex condition. MATERIALS AND METHODS Diagnosis and treatment protocol of condylar osteochondroma patients combined with secondary dentofacial deformities are discussed at the basis of published literatures and the authors' own clinical experiences. Proper treatment protocol was designed according to features of tumor and dentofacial deformities. Follow-up and radiographic examination was performed to evaluate recurrence of tumor, occlusion, joint function, and facial appearance after surgery. RESULTS The patients received 1 or several methods of resection of tumor, condylar reconstruction, correction of skeletal deformities, and treatment of malocclusion. The condylar ostechondroma and secondary dentofacial deformities were treated satisfactorily. Temporomandibular joint function, occlusion, and facial appearance were improved obviously after operation evidenced by radiographic examination and follow-up. CONCLUSION Surgical management of condylar osteochondroma with secondary dentofacial deformities requires careful patient selection, treatment planning, and precise execution. This article has reviewed the current status of surgical treatment options and provided practical guidelines for oral and maxillofacial surgeons to consider their clinical practice.
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Kim HS, Kim JY, Huh JK, Park KH. A surgical strategy for severe facial asymmetry due to unilateral condylar overgrowth. Int J Oral Maxillofac Surg 2016; 45:593-600. [DOI: 10.1016/j.ijom.2015.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 11/08/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022]
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Kim DS, Kim JY, Jeong CW, Park KH, Huh JK. Conservative condylectomy alone for the correction of mandibular asymmetry caused by osteochondroma of the mandibular condyle: a report of five cases. J Korean Assoc Oral Maxillofac Surg 2015; 41:259-64. [PMID: 26568928 PMCID: PMC4641217 DOI: 10.5125/jkaoms.2015.41.5.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/24/2015] [Accepted: 08/14/2015] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Dong Sung Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Chan-Woo Jeong
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Kwang-Ho Park
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
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Parmar BS, Garg B, Mehta RD, Midha A, Thakkar DK. Ramus Condyle Unit Reconstruction Using Vertical Ramus Osteotomy in Temporomandibular Joint Ankylosis. J Maxillofac Oral Surg 2015. [PMID: 26225055 DOI: 10.1007/s12663-014-0739-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Treatment of bony Temporomandibular Joint (TMJ) Ankylosis includes release of the ankylosis and creation of a gap with or without insertion of interposing material and complete reconstruction of the joint using e.g. costochondral, autogenous coronoid/ankylosed mass, sternoclavicular, clavicular bone grafts etc. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry, deviated mouth opening and reankylosis. The authors have applied the method of vertical ramus osteotomy (VRO) on the posterior border of the mandibular ramus for reconstruction of the ramus condyle unit (RCU) as a pedicled graft along with Myofascial Temporalis Interposition for the correction of TMJ Ankylosis. MATERIALS AND METHODS Ten patients of TMJ Ankylosis were included in this study. All ten patients were treated using VRO for the RCU reconstruction with posterior border of mandibular ramus after Gap Arthroplasty. Temporalis myofascial flap was used as an interpositional material in all patients. Patients were followed from 20 to 30 months (mean 24 months). RESULTS As a result of successful procedure the post-operative maximal mouth opening of 32-45 mm (mean 37 mm) was achieved. No patient experienced pain and infection at surgical site. None of the patients had graft rejection and reankylosis at follow-up. CONCLUSION The results showed that VRO on the posterior border of the mandibular ramus seems to be an alternative and promising method for RCU reconstruction in patients with TMJ Ankylosis.
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Affiliation(s)
- Babu S Parmar
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat India
| | - Balram Garg
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Rohtak, India
| | - Reedham D Mehta
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat India
| | - Ankita Midha
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat India
| | - Dixit K Thakkar
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat India
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Li H, Hu J, Luo E, Zhu S, Li J. Treatment of Osteochondroma in the Mandibular Condyle and Secondary Dentofacial Deformities Using Surgery Combined With Orthodontics in Adults. J Oral Maxillofac Surg 2014; 72:2295-317. [DOI: 10.1016/j.joms.2014.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 11/24/2022]
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Dominguez MF, Castillo JLD, Guerra MM, Sanchez RS, La Plata MMD. Condylar osteochondroma treated with total condylectomy and preservation of the articular disc: a case report. Craniomaxillofac Trauma Reconstr 2014; 8:136-40. [PMID: 26000086 DOI: 10.1055/s-0034-1393727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/15/2014] [Indexed: 10/24/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Mario Muñoz Guerra
- Department of Oral and Maxillofacial Surgery, La Princesa University Hospital, Madrid, Spain
| | - Ruth Sanchez Sanchez
- Department of Oral and Maxillofacial Surgery, University Hospital Montepríncipe, Madrid, Spain
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Wolford LM, Movahed R, Dhameja A, Allen WR. Low Condylectomy and Orthognathic Surgery to Treat Mandibular Condylar Osteochondroma: A Retrospective Review of 37 Cases. J Oral Maxillofac Surg 2014; 72:1704-28. [DOI: 10.1016/j.joms.2014.03.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
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Jaw deviation and ankylosis caused by condylar osteochondroma: long-term treatment outcome. J Oral Maxillofac Surg 2014; 72:604.e1-14. [PMID: 24528566 DOI: 10.1016/j.joms.2013.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 11/20/2022]
Abstract
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.
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Chen MJ, Yang C, Qiu YT, He DM, Zhou Q, Huang D, Shi HM. Local resection of the mass to treat the osteochondroma of the mandibular condyle: Indications and different methods with 38-case series. Head Neck 2013; 36:273-9. [PMID: 23509014 DOI: 10.1002/hed.23218] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/09/2022] Open
Affiliation(s)
- Min-Jie Chen
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Chi Yang
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Ya-Ting Qiu
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Dong-Mei He
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Qin Zhou
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Dong Huang
- Department of Oral and Maxillofacial Surgery; Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology; Shanghai China
| | - Hui-Min Shi
- Department of Oral and Maxillofacial Surgery; First Teaching Hospital of Xinjiang Medical University; Urumuqi Xinjiang China
- Department of Radiology; Ninth People's Hospital; Shanghai Jiao Tong University; School of Medicine; Shanghai China
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The clinical and radiographic characteristics of condylar osteochondroma. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e66-74. [DOI: 10.1016/j.oooo.2012.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/13/2012] [Accepted: 01/18/2012] [Indexed: 11/19/2022]
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23
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Khadka A, Hu J. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future. Int J Oral Maxillofac Surg 2011; 41:94-102. [PMID: 22088390 DOI: 10.1016/j.ijom.2011.10.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 07/26/2011] [Accepted: 10/20/2011] [Indexed: 11/25/2022]
Abstract
Temporomandibular joint (TMJ) ankylosis is characterized by difficulty or inability to open the mouth due to fusion of the temporal and the mandible, resulting in facial symmetry/deformity, malocclusion and dental problems. The only treatment option for TMJ ankylosis is surgical with or without condylar reconstruction. Various autogenous grafts are available for condylar reconstruction after freeing the ankylotic mass such as costochondral, sternoclavicular, fibular, coronoid, and metatarsophalangeal. Costochondral graft is preferred by surgeons, but distraction osteogenesis is slowly gaining popularity and may ultimately become the standard procedure, providing a cost-effective approach with low morbidity and excellent functional outcomes. Tissue engineering is another budding field which has shown promising results in animal studies but has not been applied to humans. To date, there is no ideal autogenous graft for condylar reconstruction that satisfies the complex anatomy and the myriad of functions of a missing condyle.
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Affiliation(s)
- A Khadka
- State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, Sichuan University, West China College of Stomatology, Chengdu 610041, China
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Roychoudhury A, Bhatt K, Yadav R, Bhutia O, Roychoudhury S. Review of Osteochondroma of Mandibular Condyle and Report of a Case Series. J Oral Maxillofac Surg 2011; 69:2815-23. [DOI: 10.1016/j.joms.2010.10.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 08/02/2010] [Accepted: 10/07/2010] [Indexed: 11/28/2022]
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25
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Liu Y, Khadka A, Li J, Hu J, Zhu S, Hsu Y, Wang Q, Wang D. Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2011; 40:1238-45. [PMID: 21620677 DOI: 10.1016/j.ijom.2011.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 02/23/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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26
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One-stage treatment of acquired facial deformity caused by severe unilateral condylar hyperplasia. J Craniofac Surg 2011; 22:1966-8. [PMID: 21959484 DOI: 10.1097/scs.0b013e31822eaa8b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Condylar hyperplasia (CH) is a rare and self-limiting process manifesting between the first and third decades of life. It causes facial asymmetry and derangement of occlusion. The management involves resection of the condylar head and orthognathic surgery followed by orthodontic treatment. We present a 33-year-old man with spontaneous onset of CH during a span of 10 years. This was managed with resection of the condyle alone, which dramatically improved facial asymmetry in addition to restoration of the occlusion within a few months of follow-up. Therefore, orthognathic surgery or orthodontic treatment was not needed.
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27
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Mehrotra D, Dhasmana S, Kamboj M, Gambhir G. Condylar hyperplasia and facial asymmetry: report of five cases. J Maxillofac Oral Surg 2011; 10:50-6. [PMID: 22379321 DOI: 10.1007/s12663-010-0141-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 11/24/2010] [Indexed: 11/30/2022] Open
Abstract
Condylar hyperplasia of mandible is overdevelopment of condyle, unilaterally or bilaterally, leading to facial asymmetry, mandibular deviation, malocclusion and articular dysfunction. This is a series of five such patients managed at our centre.
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Pediatric TMJ Ankylosis: Treatment Using Vertical Sliding Osteotomy of the Mandibular Ramus. ACTA ACUST UNITED AC 2011. [DOI: 10.5466/ijoms.9.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Takata Y, Koeda S, Inahara H, Kumamoto H, Kawamura H. Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease) of the temporomandibular joint: A case report. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ajoms.2009.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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30
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Ord R, Warburton G, Caccamese J. Osteochondroma of the condyle: review of 8 cases. Int J Oral Maxillofac Surg 2010; 39:523-8. [DOI: 10.1016/j.ijom.2010.02.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 11/01/2009] [Accepted: 02/12/2010] [Indexed: 11/24/2022]
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Use of ramus osteotomy for the treatment of osteochondroma in the mandibular condyle. J Oral Maxillofac Surg 2009; 67:676-80. [PMID: 19231801 DOI: 10.1016/j.joms.2008.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 07/02/2008] [Indexed: 11/22/2022]
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32
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Markiewicz MR, Margarone JE. Modified channel retractor for the sagittal split ramus osteotomy: A technical note. J Craniomaxillofac Surg 2008; 36:269-72. [DOI: 10.1016/j.jcms.2008.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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