A case of right hemimandibular hypertrophy treated by high condylectomy of the right side followed by recontouring of the lower border with superior repositioning of inferior alveolar neurovascular bundle

Abstract

Hemimandibular hypertrophy is a unilateral excessive growth of the mandible, which creates facial asymmetry. The condition can occur before or during the adolescent growth spurt but usually becomes apparent only after the adolescent growth spurt, when one side of the mandible continues to grow. The deformity in hemimandibular hypertrophy affects the body as well as the ramus of the mandible. In some patients, the head of the condyle remains approximately normal in size, but the length of the condylar neck increase; while in others, the condylar head enlarges.If progressive deformity requires removing the condylar growth site, the surgical options for the affected side consists of excision of bone at the head of the condyle, then recon touring or repositioning the bony stump which was done in our case, removing the condyle and condylar process and reconstructing the area either with a costrochondral junction transplant or with a free graft. Typically, a downward bowing of the mandibular body exists that can be corrected by removing bone from the lower border on the affected side. In addition, a sagittal split osteotomy on the unaffected side will allow proper positioning of the mandible. In some cases in adults, if the maxilla is canted because of excessive vertical growth on the affected side, maxillary surgery may also be required.