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Yang X, Wang M, Gao W, Wan D, Zheng J, Zhang Z. Chondroblastoma of mandibular condyle: Case report and literature review. Open Med (Wars) 2021; 16:1372-1377. [PMID: 34595350 PMCID: PMC8439264 DOI: 10.1515/med-2021-0352] [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] [Received: 02/14/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023] Open
Abstract
Chondroblastoma is one of the uncommon benign bone tumors, particularly when located in the mandibular condyle. Such a location makes its diagnosis difficult when based on only its clinical presentation and radiographic features. Herein the current report presents a case of chondroblastoma of the mandibular condyle: its clinical presentation, radiographic features, and immediate condylar reconstruction after resection. Additionally, the relevant literature is discussed to provide clinical recommendations for its diagnosis and treatment. Chondroblastoma has been reported so infrequently in the temporomandibular joint (TMJ), more common entities should first be considered in the differential diagnosis of masses in this location. Osteochondroma is the most frequent bone neoplasm in the TMJ. Since a correct diagnosis is difficult, additional tools, such as magnetic resonance imaging (MRI) and immunohistochemical analyses, should be used for diagnostics and surgical planning.
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Affiliation(s)
- Xiaoqin Yang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Manyi Wang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Wenfeng Gao
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Di Wan
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Junfa Zheng
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Zhaoqiang Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
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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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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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Park SH, An JH, Han JJ, Jung S, Park HJ, Oh HK, Kook MS. Surgical excision of osteochondroma on mandibular condyle via preauricular approach with zygomatic arch osteotomy. Maxillofac Plast Reconstr Surg 2017; 39:32. [PMID: 29109944 PMCID: PMC5655402 DOI: 10.1186/s40902-017-0129-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/13/2017] [Indexed: 05/29/2023] Open
Abstract
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.
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Affiliation(s)
- Sang-Hoon Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
| | - Jun-Hyeong An
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
| | - Jeong Jun Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 77, Yongbongro, Buk-Gu, Gwangju, 500-757 Korea
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Luo X, Ren X, Li T, Li Y, Ye B, Zhu S. Ipsilateral sagittal split ramus osteotomy to facilitate reconstruction of the temporomandibular joint after resection of condylar osteochondroma. Br J Oral Maxillofac Surg 2017; 55:604-608. [DOI: 10.1016/j.bjoms.2017.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
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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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Computer-assisted surgical planning and simulation for unilateral condylar benign lesions causing facial asymmetry. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:453-458. [PMID: 28153564 DOI: 10.1016/j.oooo.2016.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/25/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the best surgical sequence for the treatment of unilateral condylar benign lesions causing facial asymmetry by applying computer-assisted surgical planning and simulation. STUDY DESIGN Computed tomography (CT) data from 12 patients whose maxillary cant was corrected by maintaining the vertical position of the central incisors and equally intruding the long side of the maxilla and extruding the short side were analyzed by ProPlan CMF 1.4 software (Materialise Medical, Leuven, Belgium). Condylectomy and double jaw orthognathic surgery with 2 different surgical sequences were simulated: 1) maxillary LeFort I osteotomy first (MaxF), then condylectomy, followed by bilateral sagittal split ramus osteotomy (BSSO); and 2) mandible first (ManF), beginning with condylectomy, then BSSO, and lastly LeFort I osteotomy. The greatest space between the maxillary and mandibular first molar in the interim positions was measured virtually to compare the 2 surgical sequences. RESULTS The vertical distance between the upper and lower teeth of ManF patients was significantly smaller than that of MaxF patients (mean 2.99 mm, P < .001). CONCLUSION When occlusal cants are corrected by equally intruding one side and extruding the other side of the maxillary dentition, the interim position is more conducive to sequencing corrective surgery by performing condylectomy, then BSSO, followed by Le Fort I osteotomy.
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Tanaka E, Shiota C, Sato M, Fujihara S, Kondoh T, Kuroda S. Unilateral mandibular condylar osteochondroma treated with ipsilateral condylectomy and contralateral ramus osteotomy. Am J Orthod Dentofacial Orthop 2016; 149:740-50. [DOI: 10.1016/j.ajodo.2015.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/26/2022]
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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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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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Computer-Assisted Local Resection for Exostosis Osteochondroma of the Mandibular Condyle. J Craniofac Surg 2013; 24:e446-9. [DOI: 10.1097/scs.0b013e3182942f3f] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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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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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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Yang X, Hu J, Zhu S, Liang X, Li J, Luo E. Computer-assisted surgical planning and simulation for condylar reconstruction in patients with osteochondroma. Br J Oral Maxillofac Surg 2011; 49:203-8. [DOI: 10.1016/j.bjoms.2010.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 03/16/2010] [Indexed: 11/26/2022]
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Morey-Mas MA, Caubet-Biayna J, Iriarte-Ortabe JI. Osteochondroma of the temporomandibular joint treated by means of condylectomy and immediate reconstruction with a total stock prosthesis. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2011; 1:e4. [PMID: 24421981 PMCID: PMC3886071 DOI: 10.5037/jomr.2010.1404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 10/22/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Osteochondromas are one of the most common benign tumours of bone, but they are rare in the craniofacial region. These condylar tumours have been variably treated, including resection through local excision or condylectomy with or without reconstruction. METHODS A case of osteochondroma of the mandibular condyle and cranial base arising concurrently in the 76 years old patient was presented. The surgical excision of the skull base lesion and condylectomy with immediate reconstruction of temporomandibular joint was applied. RESULTS Based on the history, clinical examination and radiographic findings, osteochondroma of the skull base was diagnosed, with a concurrent lesion of the condylar process. Treatment methods for this patient included excision of the skull base tumour and condylectomy with immediate temporomandibular joint reconstruction using appropriately sized stock total temporomandibular joint prosthesis. At the 24 month follow-up, patient was free of pain and her maximal incisal opening was maintained, with no radiographic evidence of tumour recurrence or failure of the device. CONCLUSIONS Temporomandibular joint stock total replacement prosthesis became a good option to reconstruct both the fossa and the condyle in a one-stage surgery, due to the fact that both the condylar/mandibular and the fossa implants were stable in situ from the moment of fixation, with a good outcome at 24 month follow-up, with no loosening of the screws nor failure of the device.
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Affiliation(s)
- Miguel-Angel Morey-Mas
- Department of Oral and Maxillofacial Surgery, Son Dureta University Hospital Palma de Mallorca Spain
| | - Jorge Caubet-Biayna
- Bone regeneration and Oral and Maxillofacial Surgery Unit (GBCOM), Hospital Son Dureta Insalud, Baleares Spain
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