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Karssemakers LHE, de Winter DCM, van der Pas SL, Nolte JW, Becking AG. The learning curve of transoral condylectomy; a retrospective analysis of 100 consecutive cases of unilateral condylar hyperplasia. J Craniomaxillofac Surg 2023:S1010-5182(23)00073-2. [PMID: 37353405 DOI: 10.1016/j.jcms.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/31/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023] Open
Abstract
In this study, 100 consecutive scheduled transoral condylectomies for unilateral condylar hyperplasia were included. The safety and surgical performances were assessed, using the operating time, conversion rate and complication rate. The conversion rate learning curve was evaluated with a learning curve cumulative summation (LC-CUSUM). The total conversion rate was 8.0%. The LC-CUSUM for conversion signaled at the 53th procedure, indicating sufficient evidence had accumulated that the surgeon had achieved competence. For procedures 54-100, the conversion rate was 4.0%. The operating time for the transoral condylectomy was 41.5 ± 15.3 min; when a conversion was necessary, the operating time was 101.4 ± 28.3 min (p < 0.05). The estimated operating time in the post-learning phase was 37 min, this was reached after approximately 47 procedures. There was 1 major complication of a permanent inferior alveolar nerve hypoesthesia. The complication rate was not significantly decreased after the learning curve. Within the limitations of the study, it seems that transoral condylectomy for UCH is a safe procedure with several advantages over the traditional preauricular approach. Surgeons starting this procedure should be aware of the potential complications and of the learning curve of approximately 53 procedures.
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Affiliation(s)
- L H E Karssemakers
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC/Emma Children's Hospital, And Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands; Department of Head and Neck Surgery & Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, the Netherlands.
| | - D C M de Winter
- Department of Oral and Maxillofacial Surgery, MKA Kennemer & Meer, Haarlem, the Netherlands
| | - S L van der Pas
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - J W Nolte
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC/Emma Children's Hospital, And Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC/Emma Children's Hospital, And Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, MKA Kennemer & Meer, Haarlem, the Netherlands
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Olate S, Ravelo V, Alister JP, Netto HD, Haidar ZS, Sacco R. Early Treatment of Unilateral Condylar Hyperplasia in Adolescents: Preliminary Results. J Clin Med 2023; 12:jcm12103408. [PMID: 37240513 DOI: 10.3390/jcm12103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 05/28/2023] Open
Abstract
Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a rare disease. The aim of this study was to evaluate the clinical conditions of progressive facial asymmetry in young subjects treated with high condylectomy. A retrospective study was performed including nine subjects diagnosed with UCH type 1B and progressive facial asymmetry around 12 years old with an upper canine progressing towards dental occlusion. After an analysis and a decision of treatment, orthodontics began one to two weeks prior to the condylectomy (with a mean vertical reduction of 4.83 ± 0.44 mm). Facial and dental asymmetry, dental occlusion, TMJ status and an open/closing mouth were analyzed before surgery and in the final stage of treatment, almost 3 years after surgery. Statistical analyses were performed using the Shapiro-Wilk test and a Student's t-test considering a p value of <0.05. Comparing T1 (before surgery) and T2 (once orthodontic treatment was finalized), the operated condyle showed a similar height to that observed in stage 1 with a 0.12 mm difference in height (p = 0.8), whereas the non-operated condyle showed greater height increase with an average of 3.88 mm of vertical growth (p = 0.0001). This indicated that the non-operated condyle remained steady and that the operative condyle did not register significant growth. In terms of facial asymmetry in the preoperative stage, a chin deviation of 7.55 mm (±2.57 mm) was observed; in the final stage, there was a significant reduction in the chin deviation with an average of 1.55 mm (±1.26 mm) (p = 0.0001). Given the small number of patients in the sample, we can conclude that high condylectomy (approx. 5 mm), if performed early, especially in the mixed-dentition stage before full canine eruption, is beneficial for the early resolution of asymmetry and thus the avoidance of future orthognathic surgery. However, further follow-up until the end of facial growth is required.
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Affiliation(s)
- Sergio Olate
- Division of Oral, Facial and Maxillofacial Surgery, Dental School, Universidad de La Frontera, Temuco 4780000, Chile
- Center of Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4780000, Chile
| | - Victor Ravelo
- Grupo de Investigación de Pregrado en Odontología (GIPO), Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - Juan Pablo Alister
- Division of Oral, Facial and Maxillofacial Surgery, Dental School, Universidad de La Frontera, Temuco 4780000, Chile
- Center of Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco 4780000, Chile
| | - Henrique Duque Netto
- Department of Oral and Maxillofacial Surgery, Federal University of Juiz de Fora, Juiz de Fora 36000-000, Brazil
| | - Ziyad S Haidar
- Centro de Investigación e Innovación Biomédica (CiiB), Universidad de los Andes, Santiago 7550000, Chile
- BioMAT'X R&D&I (HAiDAR I+D+i) LAB, Facultad de Odontología, Universidad de los Andes, Santiago 7550000, Chile
| | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
- Oral Surgery Department, King's College Hospital NHS Trust, London SE5 9RS, UK
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Micro-computed tomography evaluation of bone architecture in various forms of unilateral condylar hyperplasia. Int J Oral Maxillofac Surg 2022; 52:44-50. [PMID: 35680482 DOI: 10.1016/j.ijom.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022]
Abstract
Condylar hyperplasia is one of the causes of facial asymmetry and malocclusion, characterized by enlargement of the lower jaw due to excessive condyle growth activity. The aim of this study was to use micro-computed tomography (micro-CT) to evaluate the bone architecture of the condylar head and determine whether there are differences between patients with various forms of unilateral condylar hyperplasia (UCH): hemimandibular hyperplasia, elongation, and mixed form. The cohort consisted of 28 patients with a mean age of 21.9 years. All patients underwent surgical treatment (condylar shaving) for active pathological growth activity. The portion of the condylar head removed was imaged by micro-CT and subsequently evaluated. Micro-CT imaging and semiquantitative and quantitative evaluation of the bone structure (percentage bone volume, surface density, trabecular thickness, trabecular separation, degree of anisotropy, and porosity of the subchondral bone) did not reveal significant differences between the individual types of condylar hyperplasia (P > 0.05). There were no significant differences in bone structure between the anterior and posterior portions of the condylar head. No statistically significant differences between individual groups of UCH were found in the micro-CT evaluation of the condylar head bone architecture.
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Chen D, Wu JY, Kennedy KM, Yeager K, Bernhard JC, Ng JJ, Zimmerman BK, Robinson S, Durney KM, Shaeffer C, Vila OF, Takawira C, Gimble JM, Guo XE, Ateshian GA, Lopez MJ, Eisig SB, Vunjak-Novakovic G. Tissue engineered autologous cartilage-bone grafts for temporomandibular joint regeneration. Sci Transl Med 2021; 12:12/565/eabb6683. [PMID: 33055244 DOI: 10.1126/scitranslmed.abb6683] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
Joint disorders can be detrimental to quality of life. There is an unmet need for precise functional reconstruction of native-like cartilage and bone tissues in the craniofacial space and particularly for the temporomandibular joint (TMJ). Current surgical methods suffer from lack of precision and comorbidities and frequently involve multiple operations. Studies have sought to improve craniofacial bone grafts without addressing the cartilage, which is essential to TMJ function. For the human-sized TMJ in the Yucatan minipig model, we engineered autologous, biologically, and anatomically matched cartilage-bone grafts for repairing the ramus-condyle unit (RCU), a geometrically intricate structure subjected to complex loading forces. Using image-guided micromilling, anatomically precise scaffolds were created from decellularized bone matrix and infused with autologous adipose-derived chondrogenic and osteogenic progenitor cells. The resulting constructs were cultured in a dual perfusion bioreactor for 5 weeks before implantation. Six months after implantation, the bioengineered RCUs maintained their predefined anatomical structure and regenerated full-thickness, stratified, and mechanically robust cartilage over the underlying bone, to a greater extent than either autologous bone-only engineered grafts or acellular scaffolds. Tracking of implanted cells and parallel bioreactor studies enabled additional insights into the progression of cartilage and bone regeneration. This study demonstrates the feasibility of TMJ regeneration using anatomically precise, autologous, living cartilage-bone grafts for functional, personalized total joint replacement. Inclusion of the adjacent tissues such as soft connective tissues and the TMJ disc could further extend the functional integration of engineered RCUs with the host.
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Affiliation(s)
- David Chen
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Josephine Y Wu
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Kelsey M Kennedy
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Keith Yeager
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Jonathan C Bernhard
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Johnathan J Ng
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Brandon K Zimmerman
- Department of Mechanical Engineering, Columbia University, New York, NY 10032, USA
| | - Samuel Robinson
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Krista M Durney
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Courtney Shaeffer
- Department of Mechanical Engineering, Columbia University, New York, NY 10032, USA
| | - Olaia F Vila
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Catherine Takawira
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | | | - X Edward Guo
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Gerard A Ateshian
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA.,Department of Mechanical Engineering, Columbia University, New York, NY 10032, USA
| | - Mandi J Lopez
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Sidney B Eisig
- College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA. .,College of Dental Medicine, Columbia University, New York, NY 10032, USA.,Department of Medicine, Columbia University, New York, NY 10032, USA
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Aerden T, Verstraete L, Politis C. The need for secondary orthognathic surgery after high condylectomy in patients with active unilateral condylar hyperplasia. Int J Oral Maxillofac Surg 2021; 51:206-213. [PMID: 34074575 DOI: 10.1016/j.ijom.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 02/28/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
The need for secondary orthognathic surgery (OS) after a high condylectomy (HC) in patients with active unilateral condylar hyperplasia was assessed in 25 patients, reviewing patient characteristics and treatment planning. At 6-12 months after HC, 13 patients (52%) required secondary OS. The amount of mandibular dental midline shift before the HC (P=0.037), and a dental crossbite that was present before the HC (P=0.017) were significantly associated with the need for secondary OS. Overall, the mandibular dental midline coincided with the facial midline in eight patients (32%) at 2 weeks after HC. In 16% of the patients, no additional OS was needed despite this being the initial treatment plan. Additionally, the initially planned type of secondary OS was modified in six other patients. Early HC in skeletally immature patients provided very good results, both aesthetic and functional, with only two of them needing supplementary OS at 6-12 months after HC. The HC remains a valuable treatment in patients with active unilateral condylar hyperplasia, as it can eliminate the need for secondary OS and is very well tolerated by most patients.
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Affiliation(s)
- T Aerden
- OMFS-IMPATH Research Group and Department of Oral and Maxillofacial Surgery University Hospitals Leuven, Leuven, Belgium.
| | - L Verstraete
- OMFS-IMPATH Research Group and Department of Oral and Maxillofacial Surgery University Hospitals Leuven, Leuven, Belgium
| | - C Politis
- OMFS-IMPATH Research Group and Department of Oral and Maxillofacial Surgery University Hospitals Leuven, Leuven, Belgium
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Abstract
Case: This report describes a clinical case of unilateral condylar hyperplasia (CH) with unique, atypical morphology. An important feature of this report is the documentation of a series of clinical photographs of the patient, showing a gradual increase in facial asymmetry associated with the CH. The main symptom reported in this case was facial asymmetry. The main intraoral clinical features observed in the patient were contralateral crossbite and ipsilateral open bite associated with CH. Surgical reshaping of the condyle was the treatment plan for this case. Conclusions: The main take away point from this case is the importance of obtaining previous photographs of the patient at different ages during case diagnosis, which helps the clinician to determine the approximate time of commencement of CH. This case also highlights the imaging features of rarely observed atypical shape of the hyperplastic condyle.
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Affiliation(s)
- Shishir Shetty
- Oral and Craniofacial Health sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Shrihari Guddadararangiah
- Oral Medicine and Radiology, Krishnadevaraya Dental College and Hospital, Bangalore, Karnataka, 562157, India
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Efficacy of proportional versus high condylectomy in active condylar hyperplasia — A systematic review. J Craniomaxillofac Surg 2019; 47:1222-1232. [DOI: 10.1016/j.jcms.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/14/2019] [Accepted: 03/21/2019] [Indexed: 11/19/2022] Open
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An Updated Protocol for the Treatment of Condylar Hyperplasia: Computer-Guided Proportional Condylectomy. J Oral Maxillofac Surg 2019; 77:1457-1465. [PMID: 30862464 DOI: 10.1016/j.joms.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To present an updated protocol for proportional condylectomy in which virtual surgical planning and 3-dimensional (3D) printing allow precise definition of the osteotomy level. MATERIALS AND METHODS Three-dimensional mirroring was performed to generate a virtual replica of the healthy hemimandible, which was subsequently aligned and overlapped with the actual mandible to estimate the level for condylectomy. A custom-fitted 3D printed surgical guide was modeled for the condylar head to reproduce the virtual plan in the surgical scenario. The updated protocol for computer-guided condylectomy was applied to 7 patients. RESULTS All patients were followed for 12 months. Surface deviation color maps showed a strong correspondence between the virtually calculated condylectomy and the surgical outcome achieved with the aid of the surgical guide. No cases of condylar hyperplasia recurrence were observed. CONCLUSION An updated protocol based on accurate 3D analysis was performed by virtual surgical planning and 3D printing. Virtual surgical planning allows the precise definition of the level of condylectomy, and custom-made 3D printed cutting guides are useful to reproduce virtual measurements during surgical maneuvers.
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Urbano ES, Da Rocha FC, Bahia MS, Santiago RC. Condilectomia alta associada à discopexia, com mini-âncoras, no tratamento da hiperplasia condilar: relato de caso. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introdução: A hiperplasia condilar (HC) é uma patologia rara caracterizada por crescimento não neoplásico que afeta a morfologia do côndilo mandibular com deformação progressiva. Dentre os sinais mais comuns se encontram a assimetria facial e mandibular, além de possíveisalterações oclusais como mordida aberta ipsilateral e transversal contralateral. Objetivo: O objetivo do estudo foi demonstrar a eficácia terapêutica da condilectomia alta associada à discopexia, com mini-âncoras, no tratamento da hiperplasia condilar. Relato de caso: Paciente de 24 anos de idade, apresentando assimetria facial, déficit e incompetência funcional mastigatória, mordida aberta posterior ipsilateral e mordida cruzada posterior contralateral. A proposta terapêutica escolhida foi o tratamento cirúrgico com condilectomia alta e discopexia com âncora para estabilização do disco articular, através de acesso endaural para o côndilo afetado com tamponamento auricular. Foi realizado infiltração com ácido hialurônico intra-articular após sutura da cápsula articular e sutura por planos para sutura da pele. Conclusão: A condilectomia alta preveniu a progressão da deformidade facial, minimizando as sequelas funcionais e estéticas, o que visa a favorecer o tratamento das deformidades faciais através de correção ortognática em segundo momento cirúrgico.
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Nolte J, Schreurs R, Karssemakers L, Tuinzing D, Becking A. Demographic features in Unilateral Condylar Hyperplasia: An overview of 309 asymmetric cases and presentation of an algorithm. J Craniomaxillofac Surg 2018; 46:1484-1492. [DOI: 10.1016/j.jcms.2018.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022] Open
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11
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Mouallem G, Vernex-Boukerma Z, Longis J, Perrin JP, Delaire J, Mercier JM, Corre P. Efficacy of proportional condylectomy in a treatment protocol for unilateral condylar hyperplasia: A review of 73 cases. J Craniomaxillofac Surg 2017; 45:1083-1093. [DOI: 10.1016/j.jcms.2017.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/02/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022] Open
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Fukushima S. A controversy with respect to occlusion. JAPANESE DENTAL SCIENCE REVIEW 2016; 52:49-53. [PMID: 28408956 PMCID: PMC5390333 DOI: 10.1016/j.jdsr.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 02/03/2016] [Accepted: 02/17/2016] [Indexed: 11/05/2022] Open
Abstract
There are very little controversies on occlusion in healthy individuals, where centric relation is regarded as the criterion for assessing the present occlusion and also for establishing a new occlusal relationship between the upper and the lower jaws. On the other hand, the occlusal position in patients with deformed condyles still remains to be clarified. In this review, the effectiveness and limits of centric relation in these patients are discussed. In addition, the muscle induced occlusal positions, such as the muscular position and the terminal positions of habitual closing movements, are suggested as a substitution for centric relation. Finally, the importance of a stable intercuspal position, where the habitual closing movements terminate without any premature tooth contact, is emphasized.
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Affiliation(s)
- Shunji Fukushima
- Department of Fixed Prosthodontics, Tsurumi University School of Dental Medicine, 803-2-7-1012 Mamedo-cho, Kohoku-Ku, Yokohama 222-0032, Japan
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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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Ghawsi S, Aagaard E, Thygesen T. High condylectomy for the treatment of mandibular condylar hyperplasia: a systematic review of the literature. Int J Oral Maxillofac Surg 2016; 45:60-71. [DOI: 10.1016/j.ijom.2015.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 08/25/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
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Fariña R, Olate S, Raposo A, Araya I, Alister J, Uribe F. High condylectomy versus proportional condylectomy: is secondary orthognathic surgery necessary? Int J Oral Maxillofac Surg 2016; 45:72-7. [DOI: 10.1016/j.ijom.2015.07.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/05/2015] [Accepted: 07/20/2015] [Indexed: 12/01/2022]
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16
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Almeida LE, Zacharias J, Pierce S. Condylar hyperplasia: An updated review of the literature. Korean J Orthod 2015; 45:333-40. [PMID: 26629479 PMCID: PMC4664909 DOI: 10.4041/kjod.2015.45.6.333] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 11/13/2022] Open
Abstract
Condylar hyperplasia (CH) is a rare disorder characterized by excessive bone growth that almost always presents unilaterally, resulting in facial asymmetry. Classification of the different types of CH can differ depending on the authors. Correct diagnosis is critical in determining the proper treatments and timing. This paper is a review of the recent literature on the epidemiology, etiology, diagnosis, classification, and surgical treatments of CH.
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Affiliation(s)
- Luis Eduardo Almeida
- Division of Oral and Maxillofacial Surgery, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Joseph Zacharias
- Division of Oral and Maxillofacial Surgery, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, WI, USA
| | - Sean Pierce
- Division of Oral and Maxillofacial Surgery, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, WI, USA
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18
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Willems NMBK, Langenbach GEJ, Everts V, Zentner A. The microstructural and biomechanical development of the condylar bone: a review. Eur J Orthod 2013; 36:479-85. [PMID: 24375755 DOI: 10.1093/ejo/cjt093] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Bone constantly strives for optimal architecture. Mandibular condyle, which is subjected to various mechanical loads forcing it to be highly adaptive, has a unique structure and a relatively high remodelling rate. Despite the eminent clinical relevance of mandibular condyle, literature on its structural and biomechanical development and on the mechanical role of its mineralized and non-mineralized bone components is scarce. OBJECTIVE The aim of the present review is to provide a brief introduction to basic bone mechanics and a synopsis of the growth and development of human mandibular condyle. Subsequently, the current ideas on the relationship between the structural and biomechanical properties of bone in general and of mandibular condyle in particular are reviewed. Finally, up-to-date knowledge from fundamental bone research will be blended with the current knowledge relevant to clinical dentistry, above all orthodontics. METHODS A comprehensive literature study was performed with an emphasis on recent and innovative work focusing on the interaction between microarchitectural and micromechanical properties of bone. CONCLUSIONS Mandibular condyle is a bone structure with a high bone turnover rate. Mechanical properties of mandibular condyle improve during adolescence and are optimal during adulthood. Local mineralization degree might not be a decisive determinant of the local bone tissue stiffness as was believed hitherto. Bone collagen and its cross links play a role in toughness and tensile strength of bone but not in its compressive properties. Clinical procedures might affect mandibular condyle, which is highly reactive to changes in its mechanical environment.
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Affiliation(s)
- Nop M B K Willems
- Departments of *Orthodontics and**Oral Cell Biology and Functional Anatomy, MOVE Research Institute, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, the Netherlands
| | - Geerling E J Langenbach
- **Oral Cell Biology and Functional Anatomy, MOVE Research Institute, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, the Netherlands
| | - Vincent Everts
- **Oral Cell Biology and Functional Anatomy, MOVE Research Institute, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, the Netherlands
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Alyamani A, Abuzinada S. Management of patients with condylar hyperplasia: A diverse experience with 18 patients. Ann Maxillofac Surg 2013; 2:17-23. [PMID: 23483790 PMCID: PMC3591071 DOI: 10.4103/2231-0746.95311] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose was to report the clinical experience with patients diagnosed with Condylar Hyperplasia (CH). MATERIALS AND METHODS Eighteen patients with CH underwent condylar growth assessment using clinical and radiographic examinations. Seven patients with suspected active condyles underwent single photo emission computed tomography (SPECT) examination. A total of patients with asymmetry and malocclusion were treated with orthognathic surgery. Three patients with intact occlusion; underwent inferior border osteotomy with nerve repositioning. All patients were followed up for 3 years without any complications. CONCLUSION There is great diversity in the clinical and radiographic presentation in cases with CH. Assessment of condylar growth activity is the cornerstone in managing these cases. After that each case has its own diverse treatment plan to achieve a satisfactory facial symmetry.
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Affiliation(s)
- Ahmed Alyamani
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Almăşan OC, Băciuţ M, Hedeşiu M, Bran S, Almăşan H, Băciuţ G. Posteroanterior cephalometric changes in subjects with temporomandibular joint disorders. Dentomaxillofac Radiol 2012; 42:20120039. [PMID: 23253565 DOI: 10.1259/dmfr.20120039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the study was to establish the changes in posteroanterior cephalometric variables in subjects with temporomandibular joint disorders (TMDs). METHODS Posteroanterior cephalograms of 61 subjects (age range 16-36.6 years, standard deviation 4.88 years) were used to determine cephalometric differences. Subjects were classified according to the Research Diagnostic Criteria for Temporomandibular Joint Disorders into three groups: unilateral TMD, bilateral TMD and no TMD. 14 linear and angular measurements were assessed on the posteroanterior cephalogram. For assessing facial asymmetry, the asymmetry index for bilateral measurements was calculated between the right and the left side. In cases with unilateral TMD, the asymmetry index was calculated using the difference between the unaffected and affected side. The differences among multiple groups were analysed using the one-way analysis of variance test and Scheffé post hoc test. RESULTS 47 subjects were females (77%) and 14 were males (23%). 19 subjects had unilateral TMDs and 16 subjects had bilateral TMDs. The asymmetry index of the distance from the horizontal plane to the antegonion was higher in subjects with unilateral TMD than in patients with bilateral or no TMD (p < 0.05). Also, the asymmetry index of the distances from the vertical plane to the condyle (p = 0.05), gonion (Go) (p = 0.0004), antegonion (p = 0.002) and chin (Ch) (p = 0.02) was higher in subjects with unilateral TMDs. The asymmetry index of the O point-Go-Go' and O point-Ch-Ch' angles differed significantly in subjects with unilateral TMDs (p < 0.05). CONCLUSIONS Unilateral TMDs are associated with changes in posteroanterior cephalometric measurements. The assessment of posteroanterior cephalometric variables could be used as a key factor for evaluating the presence of TMDs.
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Affiliation(s)
- O C Almăşan
- Department of Prosthetic Dentistry, Faculty of Dentistry, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
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