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

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.

A Novel Technique for Resection and Reconstruction of the Temporomandibular Joint by Sliding Vertical Ramus Osteotomy using Only Submandibular Approach

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.

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.

Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series

The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO). Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the "new condyle" and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8-12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the "new condyle" moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved. Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.

Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma

BACKGROUND

Osteochondroma (OC) is one of the most common benign tumors of the long bones, but it rarely occurs in the maxillofacial skeleton. However, mandibular condylar OC often leads to severe facial deformity in affected patients, including facial asymmetry, deviation of the chin, and malocclusion. This study aimed to explore the clinical application of individualized 3D-printed templates to accurately and effectively treat condylar OC.

METHODS

A total of 8 patients with mandibular condylar OC were treated from July 2015 to August 2021. The enrolled patients (5 women and 3 men) had a median age of 27 years (range: 21-32 years). All patients exhibited symptoms of facial asymmetry and occlusal disorders preoperatively. The digital software used to virtually design the process consisted of three-dimensional reconstruction, 3D-cephalometry analysis, virtual surgery, individualized templates, and postoperative facial soft-tissue prediction. A set of 3D-printed templates (DOS and DOT) were used in all cases to stabilize the occlusion and guide the osteotomy. Then, pre- and post-operative complications, mouth opening, clinical signs, and the accuracy of the CT imaging analysis were all evaluated. All the measurement data were presented as means ± SD; Bonferroni and Tamhane T2 multiple comparison tests were used to examine the differences between the groups.

RESULTS

All patients healed uneventfully. None of the patients exhibited facial nerve injury at follow-up. In comparing the condylar segments with T0p and T1, the average deviation of the condylar segments was 0.5796 mm, indicating that the post-operative reconstructed condyles showed a high degree of similarity to the reconstruction results of the virtual surgical plan.

CONCLUSIONS

Individualized 3D-printed templates simplified surgical procedures and improved surgical accuracy, proving to be an effective method for the treatment of patients with slight asymmetric deformities secondary to condylar OC.

Temporomandibular joint arterial variability

The study aimed to investigate temporomandibular joint (TMJ) arterial variability. In this prospective study, the vasculature variability was studied using a 3D volume rendering CT angiography including random patients at two hospitals. A 16-quadrant (A1-D4) evaluation grid was developed using the Frankfurt plan as main reference. For each quadrant, the number of arterial ramus or branches was scored as clearly visible (2), partially visible (1), or not visible (0). A total of 50 patients were enrolled (mean age of 62.9 ± 16.0); 21 (42%) were men, and 29 (58%) were women. The authors observed bilaterally higher arterial density in the posterior aspect of the ascending ramus of the mandible (p < 0.0001), corresponding to quadrants B2 (5.92 ± 2.27 and 6.14 ± 2.56), B3 (9.76 ± 2.97 and 11.18 ± 2.86) and B4 (7.38 ± 2.78 and 8.10 ± 2.42). A strong correlation was found between the number of vessels and the variability of the region (r = 0.87, p = 0.00001). No differences were observed between men and women. Within the limitations of the study, arterial variability was observed in the TMJ territory. The posterior zone of the condyle and ramus is the most vascularized area, with great variability, representing an increased risk for surgical bleeding. Therefore, this knowledge seems to be particularly relevant for surgeons dedicated to TMJ and other facial surgery or facial/cerebral radiologic interventions. The authors encourage future studies to include larger samples and to identify thoroughly the arterial branches in this area.