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Iwai T, Sugiyama S, Ohashi N, Hirota M, Ito K, Mitsudo K. Endoscopically-assisted intraoral resection of osteochondroma of the mandibular condyle with a piezoelectric surgical device. Cranio 2024; 42:305-308. [PMID: 34275422 DOI: 10.1080/08869634.2021.1953824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Osteochondromas of the mandibular condyle show facial asymmetry and malocclusion. Because condylar osteochondromas are generally resected in a preauricular approach with risks of facial nerve injury and visible scar, the authors report endoscopically assisted intraoral resection of osteochondroma of the mandibular condyle with a piezoelectric surgical device.Case presentation: A 38-year-old woman presented with malocclusion and facial asymmetry caused by deviation of the chin to the left. Computed tomography showed a hyperdense, well-circumscribed mass arising from the medial aspect of the right mandibular condyle with resorption of the skull base. The patient underwent an endoscopically-assisted intraoral condylectomy with a piezoelectric surgical device. The postoperative course was uneventful without trismus, malocclusion, or facial asymmetry, and there was no recurrence 4 years after surgery.Conclusion:Endoscopically assisted intraoral resection of osteochondroma of the mandibular condyle with a piezoelectric surgical device is a minimally invasive and safe surgery.
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Affiliation(s)
- Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Kanagawa, Japan
| | - Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Kanagawa, Japan
| | - Nobuhide Ohashi
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Kanagawa, Japan
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, Kanagawa, Japan
| | - Ko Ito
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Kanagawa, Japan
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Ma W, Niu S, Wang L, Peng C, Fu S, Zhang C, Cui Q, Wang S, Li M, Xu Y. Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma. Healthcare (Basel) 2022; 10:2163. [PMID: 36360504 PMCID: PMC9690499 DOI: 10.3390/healthcare10112163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 10/29/2023] Open
Abstract
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.
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Affiliation(s)
- Wen Ma
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Shiwei Niu
- Yunnan Key Laboratory of Stem Cell and Regenerative Medicine, Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming 650500, China
| | - Lidong Wang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Canbang Peng
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Shuai Fu
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Changbin Zhang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Qingying Cui
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Sihang Wang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Ming Li
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Yanhua Xu
- Department of Orthodontics, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
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Liu K, Xue X, Yu J, Abdelrehem A, Zhang L, Dai J, Wang X. Effect of condylar osteochondroma resection through an intraoral approach on the masticatory functions: a preliminary evaluation based on occlusion and temporomandibular joint functions. Br J Oral Maxillofac Surg 2020; 59:286-291. [PMID: 33589310 DOI: 10.1016/j.bjoms.2020.08.027] [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: 11/14/2019] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- K Liu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - X Xue
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - J Yu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - A Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - L Zhang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China
| | - J Dai
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.
| | - X Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, China.
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Li MZ, Wang XX, Li ZL, Yi B, Liang C, He W. [Accuracy analysis of computer assisted navigation for condylectomy via intraoral approach]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:182-186. [PMID: 30773565 DOI: 10.19723/j.issn.1671-167x.2019.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the application accuracy of virtual preoperative plan after the condylectomy via intraoral approach under computer assisted surgical navigation, and to analyze the location and cause of the surgical deviation to provide reference for the surgical procedure improvement in the future. METHODS In the study, 23 cases with condylar hypertrophy (11 with condylar osteochondroma and 12 with condylar benign hypertrophy) in Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Atomatology from December 2012 to December 2016 were treated by condylectomy via intraoral approach under computer assisted surgical navigation. The patient's spiral CT data were imported into ProPlan software before operation, and the affected mandibular ramus was reconstructed three-dimensionally. The condylar osteotomy line was designed according to the lesion range, and the preoperative design model was generated and introduced into the BrainLab navigation system. Under the guidance of computer navigation, the intraoral approach was used to complete the condylar resection according to the preoperative design of the osteotomy line. Cranial spiral CT of the craniofacial region was taken within one week after operation. three-dimensional reconstruction of the mandibular ramus at the condylectomy side was performed, and the condylar section was divided into six segments (anterolateral, anterior, anteromedial, posteromedial, posterior, and posterolateral) and the corresponding regional measurement points P1 to P6 were defined. Then the preoperative virtual model and the postoperative actual model were matched by Geomagic studio 12.0 to compare the differences and to analyze the accuracy of the operation. RESULTS All the patients had successfully accomplished the operation and obtained satisfactory results. Postoperative CT showed that the condyle lesion was completely resected, and the condylar osteotomy line was basically consistent with the surgical design. No tumor recurrence or temporomandibular joint ankylosis during the follow-up period. The postoperative accuracy analysis of the condylar resection showed that the confidence intervals measured by the six groups of P1 to P6 were (-2.26 mm, -1.89 mm), (-2.30 mm, -1.45 mm), (-3.37 mm, -2.91 mm), (-2.83 mm, -1.75 mm), (-1.13 mm, 0.99 mm), and(-1.17 mm, 0.17 mm), where P3 group was different from the other 5 groups. There was no significant difference between the P5 and P6 groups and the difference between the other four groups was statistically significant. CONCLUSION Under the guidance of computer navigation, the intraoral approach can be performed more accurately. The surgical deviation of each part of the osteotomy surface is mainly due to excessive resection. The anterior medial area of the anterior medial condyle represents the most excessive resection. The posterior and posterior lateral measurement points represent the posterior condylar area. The average deviation is not large, but the fluctuation of the deviation value is larger than that of the other four groups. The accuracy of computer-assisted subtotal resection has yet to be improved.
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Affiliation(s)
- M Z Li
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.,Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X X Wang
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Z L Li
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - B Yi
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - C Liang
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - W He
- Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Han B, Wang X, Li Z, Yi B, Liang C, Wang X. Hemimandibular Hyperplasia Correction by Simultaneous Orthognathic Surgery and Condylectomy Under Digital Guidance. J Oral Maxillofac Surg 2018; 76:1563.e1-1563.e18. [DOI: 10.1016/j.joms.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 11/28/2022]
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Hernández-Alfaro F, Méndez-Manjón I, Valls-Ontañón A, Guijarro-Martínez R. Minimally invasive intraoral condylectomy: proof of concept report. Int J Oral Maxillofac Surg 2016; 45:1108-14. [PMID: 27134047 DOI: 10.1016/j.ijom.2016.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/09/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Abstract
A significant proportion of facial asymmetry cases are caused by abnormal growth of the mandibular condyles. Surgical management is generally based on a condylectomy performed through a pre-auricular transcutaneous access. However, this approach entails potential neurovascular, salivary, and aesthetic complications. In this study, a proof-of-concept evaluation was performed of a novel minimally invasive technique for condylectomy performed through an intraoral approach. Based on precise three-dimensional virtual planning to define intraoperative references, this technique provides an excellent access for total or partial condylectomy through a limited intraoral incision. Piezoelectric surgery with customized attachments enables the safe, accurate execution of the condylectomy. In addition, experience gained in seven consecutive cases suggests that the need for coronoidectomy can be obviated, surgical time is reduced to an average of 16.9min, and postoperative morbidity is minimal. This alternative intraoral approach could become the treatment of choice for most condylar hyperplastic conditions.
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Affiliation(s)
- F Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Centre, Barcelona, Spain
| | - I Méndez-Manjón
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Centre, Barcelona, Spain
| | - A Valls-Ontañón
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Centre, Barcelona, Spain
| | - R Guijarro-Martínez
- Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Centre, Barcelona, Spain.
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Singh D, Gadre P, Gadre K, Setiya S. Endoscope-Assisted Intraoral Excision of Osteochondroma of the Mandibular Condyle. J Oral Maxillofac Surg 2015; 73:671-4. [DOI: 10.1016/j.joms.2014.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
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Image-Guided Endoscopic Navigation for the Precise Resection of a Mandibular Condylar Osteochondroma. J Craniofac Surg 2013; 24:e573-9. [DOI: 10.1097/scs.0b013e31829ad374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yu HB, Sun H, Li B, Zhao ZL, Zhang L, Shen SG, Wang XD. Endoscope-assisted conservative condylectomy in the treatment of condylar osteochondroma through an intraoral approach. Int J Oral Maxillofac Surg 2013; 42:1582-6. [PMID: 23790807 DOI: 10.1016/j.ijom.2013.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/19/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- H B Yu
- Department of Oral and Craniomaxillofacial Science, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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