Recurrent osteochondroma of the mandibular condyle: A case report

Osteochondroma of the Mandibular Condyle: A Rare Case Presentation With Literature Review

Osteochondromas (OCs) are benign bone tumors characterized by their growth with a cartilage cap and typically occurring at the ends of long bones. Their occurrence in the head and neck region is infrequent, accounting for only around 1% of head and neck tumors. Notably, the mandibular coronoid process and the mandibular condyle are the primary sites where an OC is reported. Patients often exhibit facial asymmetry, limited mouth opening, and malocclusion. Possible treatment options depending on the condition include partial or total condylectomy, vertical ramus osteotomy, and supplementary orthognathic surgery. The recurrence rate of under 1%- 2% is reported after local resection.  In this case report, we present a unique case of an OC in a 27-year-old woman. It involved the mandibular condyle, resulting in a left-sided mouth deviation while opening and closing her mouth. The purpose of this article is to detail the clinical and radiographic features, histopathological aspects, and treatment strategies and differentiate potential diagnoses, for such OCs.

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.

Imaging features of cartilaginous tumors of the head and neck

There is a wide spectrum of head and neck cartilaginous lesions which include both neoplastic and nonneoplastic processes. Cartilaginous tumors of the head and neck are uncommon, posing a diagnostic challenge. Benign cartilaginous tumors that may occur in the head and neck include chondroma, chondroblastoma, chondromyxoid fibroma, osteochondroma, and synovial chondromatosis. Chondromesenchymal hamartoma is a rare non-neoplastic cartilaginous lesion that is included for the 1first time in the new WHO classification and radiologically can mimic a tumor. Malignant cartilaginous tumors include chondrosarcoma and chondroid variant of chordoma. Characteristic tumor locations, internal chondroid matrix calcification, and typical T2 hyperintense signal secondary to high-water content within the extracellular matrix of the hyaline cartilage are useful imaging features that narrow the differential diagnosis and help in diagnosing these diseases. This article presents a narrative review of the anatomy of the head and neck cartilaginous structures, discusses the current knowledge and imaging spectrum of benign and malignant cartilaginous tumors and tumor-like lesions of the head and neck.

Giant Osteochondroma of the mandibular condyle and temporomandibular joint - A case report

Osteochondroma is one of the common bone tumours but is rarely seen in the head and neck region. Osteochondroma of the mandibular condyle, extending to the temporomandibular joint (TMJ) is an infrequent occurrence. Patients commonly present with restricted mouth opening and malocclusion. Due to the significant overlap in features between chondromas and condylar hyperplasia, it is very likely to be misdiagnosed, resulting in treatment errors. In this report, an interesting case of a large osteochondroma of the mandibular condyle extending into the zygomatic and petrous part of the temporal bone involving the left TMJ in a 35-year-old female patient is described who presented with facial asymmetry and restricted mouth opening. This paper outlines the clinico-radiographic and histopathological features for diagnosis and appropriate treatment of osteochondroma.

Osteochondroma of the coronoid process: A case report and review of the literature

Osteochondroma (OC) is considered the most common tumor of the axial skeleton, although it is relatively uncommon in the craniofacial region. The present study describes an atypical case of OC of the coronoid process. A 34-year-old woman presented with severely limited mouth opening (5 mm) and swelling of the right zygoma. Cone-beam computed tomography (CBCT) revealed a mushroom-shaped outgrowth from the coronoid process to the inner surface of the zygomatic arch, forming a pseudojoint. The patient was treated with coronoidectomy via an intraoral approach. Histopathological examination revealed features suggestive of OC. Subsequently, the patient was able to open their mouth, and there was no evidence of recurrence or post-operative complications in the 21-month follow-up. A review of the literature revealed only 38 histologically proven cases of coronoid OC in the past 30 years (1989-2018). The incidence of the disease was higher in men compared with that in women (male:female, 2.17:1), and the median age at onset was 28.7 years, with a range of 5-57 years. Gradual limitation of mouth opening and facial asymmetry are the most noticeable symptoms. Water's view and submentovertex projection of the zygomatic arch may be useful in identifying the tumor and its association with the zygoma, while CT and CBCT permit a detailed visualization of the location and density of the tumor. Coronoidectomy is the preferred treatment option, and the prognosis is excellent, with no evidence of recurrence or malignant transformation.

Osteochondroma condyle: A journey of 20 years in a 52-year-old male patient causing severe facial asymmetry and occlusal derangement

Mandibular condylar osteochondroma (OS) is a rare lesion though most common benign tumor of the axial skeleton. OSs are slow-growing tumors originating from the cortex of the bone resulting in facial asymmetry, temporomandibular dysfunction and occlusal derangement. We present an extremely rare case of OS of the mandibular condyle in a 52-year-old male patient who presented to our hospital with gradual deviation of the lower jaw, difficulty in opening the mouth and chewing the food for 20 years with clinicoradiological and pathological correlation.