Using Conservative Condylectomy for Management of a Large Osteochondroma of the Mandibular Condyle With 6-Year Follow-up:

Guideline for the Treatment of Condylar Osteochondroma Combined With Secondary Dentofacial Deformities

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.

Osteochondroma of the condyle: case report with 15 years of follow-up

Osteochondromas (OC) in the craniofacial region are very rare. Following on from a literature review published in 2011, further single case reports and case series are reviewed herein. To date, approximately 235 studies on OC of the mandibular condyle have been published in the English language literature. There is debate regarding the surgical techniques for treatment. Whereas the use of condylectomy has shown no recurrences, follow-up of conservative excision of the tumour has shown recurrence in three cases. One of these relates to the case presented here, which was first reported in 2002. The patient has declined any further surgery since that date. The tumour has shown no further growth and there is no functional impairment. This underlines Cottrell's claim that excision of the entire cartilage cap appears to stop the growth of the tumour and represents the most important focus of surgical treatment.

Conservative condylectomy alone for the correction of mandibular asymmetry caused by osteochondroma of the mandibular condyle: a report of five cases

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.

Bimaxillary orthognathic surgery and condylectomy for mandibular condyle osteochondroma: a case report

Osteochondroma is rarely reported in the maxillofacial region; however, it is prevalent in the mandibular condyle. This slowly growing tumor may lead to malocclusion and facial asymmetry. A 39-year-old woman complained of gradual development of anterior and posterior unilateral crossbite, which resulted in facial asymmetry. A radiological study disclosed a large tumor mass on the top of the left mandibular condyle. This bony tumor was surgically removed through condylectomy and the remaining condyle head was secured. Subsequently, bimaxillary orthognathic surgery was performed to correct facial asymmetry and malocclusion. Pathological diagnosis was osteochondroma; immunohistochemistry showed that the tumor exhibited a conspicuous expression of BMP-4 and BMP-2 but rarely expression of PCNA. There was no recurrence at least for 1 year after the operation. Patient’s functional and esthetic rehabilitation was uneventful.