Condylar Hyperplasia Research Articles

Correlation of Cephalometric Analyses With Clinical Impression in Orthognathic Surgery Patients: Harvold and Steiner Analyses

A variety of linear (Harvold) and angular (Steiner) cephalometric analyses are used to identify the skeletal basis for a malocclusion; there is no universally accepted standard. The purpose of this study was to compare the concordance of Harvold and Steiner analyses with the clinicians' impression of maxillary and mandibular jaw position. We conducted a retrospective cohort study of patients who underwent orthognathic surgery at Massachusetts General Hospital from 2012 through 2016. Patients were included if they had symmetrical deformities not related to trauma, clefts, or syndromes; complete records; and a clinical diagnosis documented at initial consultation. The predictor variables were Harvold- and Steiner-derived diagnoses of jaw position (hypoplasia, neutral, or hyperplasia). The outcome variables were maxillary and mandibular clinical impressions (hypoplasia, neutral, or hyperplasia). The concordance, sensitivity, specificity, positive predictive value (PPV), and negative predictive value relative to clinical diagnoses were calculated. During the study period 388 patients had orthognathic surgery and 222(112 females, mean age 26.4±9.9 years) met the inclusion criteria. Harvold and Steiner analyses were 82% and 33% concordant with the maxillary clinical impression, respectively (P<.001), and 62% and 52% concordant with the mandibular clinical impression, respectively (P=.044). Steiner analysis had greater concordance in females (P<.001). For maxillary hypoplasia, the maxillary unit length had a sensitivity of 87%, specificity of 36%, and PPV of 92% and the sell-nasion-A (SNA) point had 28%, 84%, and 93%, respectively.For mandibular hypoplasia, the mandibular unit length had a sensitivity of 52%, specificity of 96%, and PPV of 94% and the sell-nasion-B (SNB) point had 52%, 98%, and 97%, respectively. For mandibular hyperplasia, the mandibular unit length had a sensitivity of 46%, specificity of 93%, and PPV of 40% and the SNB point had 73%, 73%, and 23%, respectively. Harvold analysis was significantly more consistent with the clinical impression of the maxillary and mandibular sagittal position than Steiner analysis. Both analyses were highly specific and had high PPVs to confirm the clinical impression. Clinicians should consider incorporating Harvold analysis during treatment planning for orthognathic surgery.

Single-stage surgical treatment of condylar hyperplasia

Background: Unilateral Mandibular Condylar Hyperplasia (CH) is a rare idiopathic disorder which can cause both occlusal dysfunction and progressive facial deformity. Although there is a consensus in growing patients with active (CH) that the surgical treatment should be restricted to high condylectomy procedure which not only stop the aggravation of the hard and soft tissue asymmetry, but also can cause a regression of the deformity. The treatment of active (CH) in adult patients is still controversial. The level of condylectomy, the appropriate orthognathic surgical procedure, the treatment sequences, the number and diversity of surgeries are still debatable.

Proportional condylectomy and orthodontic treatment with aligners in unilateral condylar hyperplasia: an observational study

Background: Unilateral Condylar Hyperplasia (UCH) is a pathology characterized by an excessive growth of a mandibular condyle. Nitzan et al. create a classification system based on clinical criteria, dividing condylar hyperplasia into vertical, transverse and combined forms. The Authors present a retrospective study of 14 patients treated with proportional condylectomy, functional arthroplasty (Iannetti et Cascone 1989) and aligners technique.

Surgical treatment of condylar hyperplasia: an innovative protocol

Background: Condylar hyperplasia (CH) of the mandible is a progressive overgrowth, resulting in severe facial asymmetry with functional and aesthetic impairment, worsening of a dentofacial deformity (DDF). It has been suggested that possible etiologies could comprehend trauma, infections, benign and malignant tumors, hormonal and hereditary or aberrant growth factors.

Condylar hyperplasia

Background: Condylar hyperplasia is an uncommon pathology in the maxillofacial region which creates facial asymmetries. Over time, several different classifications and treatments have been proposed.

Surgery first approach and condilectomy for management of facial asymmetry

Background: Condylar hyperplasia (CH) is a pathological condition associated with the abnormal growth of the mandibular condyles, causing alteration of the jaws in different planes, resulting in facial asymmetry. The degree of this changes depends on the time and activity of pathological growth, which, theoretically, is self-limiting along with the patient's own growth period. Even so it may go beyond or appear after the peak of growth developing more severe consequences. Establishing the correct diagnosis and the degree of asymmetry it's crucial for the management with condylectomy and / or orthognathic surgery, among other procedures.

Facial asymmetry due unilateral condylar hyperplasia: a challenging treatment

Background: Mandibular Condylar Hyperplasia (CH) is a rare condition that affects all population with slight predilection for females and the right side condyle. The mandibular overdevelopment creates severe functional and aesthetic issues. The pathogenesis is not clear, and the diagnosis is based on clinical examination complemented with panoramic x-ray and CT scan, associated to TMJ scintigraphy to evaluate the hyperplasia activity. The treatment is always difficult, once that's a three dimensional impairment.

Mandibular condylar hyperplasia: clinical, histopathologic and demographic consideration in a series of 13 cases, retrospective study

Background: Mandibular condylar hyperplasia (CH) is defined as a pathological non-neoplastic that causes overdevelopment of the condyle, creating functional problems and progressive facial asymmetry.

Surgical correction of hemifacial microsomia associated with unilateral condylar hyperplasia: case report

Surgical correction of hemifacial microsomia associated with unilateral condylar hyperplasia: case report

Condylar hyperplasia treated by simultaneous high condylectomy and orthognathic surgery: a case report

Condylar hyperplasia treated by simultaneous high condylectomy and orthognathic surgery: a case report

Role of proportional condylectomy in patients with active condylar hyperplasia

Role of proportional condylectomy in patients with active condylar hyperplasia

Correction of facial asymmetry associated with mandibular condylar hyperplasia - case report

Correction of facial asymmetry associated with mandibular condylar hyperplasia - case report

The Inverted Coronoid-Ramus Graft for Condylar Reconstruction

The purpose of this article is to describe a creative, versatile technique for condylar reconstruction using autogenous mandibular bone. The technique has been used for reconstruction of small condyle and/or ramus defects (approximately 35 to 40mm in length) typically associated with condylar hyperplasia, condylar tumors, idiopathic condylar resorption, and failed reconstruction attempts.The technique involves excision of the ipsilateral coronoid process-mandibular ramus, inverting it and rotating the segment 180° along its horizontal axis to replace the excised condyle. The resultant graft simulates the morphology of the posterior aspects of the ramus and condyle and has been shown to resist resorption typical of endochondral bone grafts harvested from the rib or iliac crest. Grafting is carried out via vestibular and preauricular or endaural incisions. Four cases followed over a period of 3 to 40months (average, 21months) are presented. No adverse functional results, including ankylosis, removal of hardware or adverse remodeling, have occurred. A period of intermaxillary fixation is used because it is considered beneficial for intra-articular scarring of the subglenoid fossa pad (disc or retrodiscal tissue and fibrocartilage) and initial healing. Physical therapy has not been prescribed. The inverted coronoid graft is a versatile technique when virtual surgical planning is used to assess feasibility, as well as defect and graft dimensions; fabricate custom bone plate and drilling guides; and determine screw osteosynthesis sites. In general terms, a post-reconstruction opening of 35mm allows for adequate function and guards from contralateral symptomatic hypermobility given disparate right- and left-sided joint mechanics. In the cases described, a mean of 40.5mm was achieved; however, in 2 of these cases, this was measured with undesirable asymptomatic (preoperative) deviation to the ipsilateral side by greater than 4mm and by 6mm. The inverted coronoid graft technique reduces operative time, can be executed with few external scars, and reduces the number of operative fields.

Is Single-Photon Emission Computed Tomography/Computed Tomography Superior to Single-Photon Emission Computed Tomography in Assessing Unilateral Condylar Hyperplasia?

Single-photon emission computed tomography (SPECT) with technetium-99m diphosphates plays an important role in assessing unilateral condylar hyperplasia (UCH). The aim of this study was to evaluate whether quantification methods of SPECT plus CT (SPECT/CT) based on precise region-of-interest (ROI) drawings made under the guide of CT images were more accurate than conventional SPECT methods in the assessment of UCH growth. This study is a nonblinded retrospective case series. Patients with UCH who had undergone SPECT/CT were enrolled. CT images were used to guide ROI drawings around the anatomic contour of the affected and contralateral condyles on SPECT/CT images versus fixed ROIs on conventional SPECT images. Mean and maximum values within the ROIs were recorded to compute percentile ratios. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves were calculated separately for SPECT-based methods (SPECTaver, SPECTmax) and SPECT/CT methods (SPECTCTaver, SPECTCTmax). The area under the ROC curve of each method was calculated and compared pairwise. Fifty-six patients (30 patients with progressive and 26 patients with nonprogressive mandibular asymmetry) were evaluated. SPECTmax had the highest sensitivity of 83.3%, followed by SPECTCTmax, SPECTaver, and SPECTCTaver. In contrast, SPECTaver, SPECTCTmax, and SPECTmax had similar specificities, PPVs, and NPVs. Nonetheless, SPECTCTaver had the lowest specificity, PPV, and NPV among all methods. ROC analysis also showed similar diagnostic performances among SPECTaver, SPECTmax, and SPECTCTmax (P>.05) and poorer diagnostic performance of SPECTCTaver compared with the other 3 methods (P<.05). The method of using ROIs drawn around the contour of the condyle on SPECT/CT images does not show improved accuracy over conventional SPECT-fixed ROI methods in assessing UCH.

An Updated Protocol for the Treatment of Condylar Hyperplasia: Computer-Guided Proportional Condylectomy

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. 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. All patients were followed for 12months. 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. 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.

Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion

Condylar displacement and remodeling are critically involved in occlusal and skeletal stability after orthognathic surgery. The aim of the present study was to characterize condylar displacement and surface remodeling after bimaxillary orthognathic surgery in adult patients with skeletal Class III malocclusion treated by the surgery-first approach (SFA) or the orthodontic-first approach (OFA). This retrospective cohort study recruited adult patients with mandibular hyperplasia treated with SFA or OFA. Simultaneous Le Fort I osteotomy for maxillary advancement and bilateral sagittal split ramus osteotomy for mandibular setback were performed in all patients. Original cone-beam computed tomographic data before surgery (T0), immediately after surgery (T1), and 12months postoperatively (T2) were collected and reconstructed for 3-dimensional (3D) quantitative analyses. Three-dimensional condylar displacement and remodeling after SFA and OFA were characterized and statistically compared by Mann-Whitney U test and χ2 test. The significance level was set at a P value less than .05. Twenty-four (male-to-female ratio, 1:2; mean age, 21.2yr) and 20 (male-to-female ratio, 1:1; mean age, 23.1yr) patients were enrolled in the OFA and SFA groups, respectively. Condylar inferolateral displacement with inward and anterior rotations from T0 to T1 and return movements from T1 to T2 were observed regardless of treatment approach. Significantly greater amount of 3D bodily shift immediately after surgery (2.04±1.05mm in SFA group vs 1.22±0.66mm in OFA group; P<.05) and downward movement 1year after surgery were observed in the SFA versus OFA group. Bone resorption in the condylar surface was prevalent and predominant in its lateral areas, whereas bone formation was frequently observed in the anteromedial area in the SFA (45%) and OFA (42.9%) groups. Similar patterns of 3D condylar displacement and surface remodeling were observed in patients treated with SFA or OFA.

Three-dimensional skeletal changes after early proportional condylectomy for condylar hyperplasia

The purpose of this study was to evaluate volumetric and dentoskeletal changes in 21 patients with active unilateral condylar hyperplasia (AUCH) after proportional condylectomy. A split-mouth design was used: control group healthy joints (HS, healthy side) and test group affected joints (AS, affected side) (21 per group). Cone beam tomography scans were obtained at T0 (preoperative), T1 (10days after the intervention), and T2 (approximately 12 months post-surgery). The condylar unit volume (CUV), articular cavity volume (ACV), and dentoalveolar units (DAUs) were measured. CUV showed a difference of 1.12cm3 between T0 and T1, increasing 0.4cm3 between T1 and T2 on AS. There was no difference between T0 and T2 on HS. ACV increased 0.65cm3 between T0 and T1 on AS, after which it decreased by 0.36cm3 at T2 (0.30cm3 larger than the initial articular cavity at T0). ACV showed no post-surgery differences on HS. Midline DAU showed extrusion of 0.20mm for maxilla and 0.52mm for mandible, while in the lateral area, maxilla was extruded by 0.3mm on HS and was intruded 0.12mm on AS. For the mandible, both sides showed extrusion (0.4–0.6mm). In the distal to canine and molar areas, intrusion of 0.2mm and 0.9mm, respectively, was observed on AS; there was extrusion of 0.6mm distal to the canine on HS. At the mandibular level, AS distal to the canine showed extrusion of 1mm, while intrusion of 0.2mm was observed in the molars. For HS, only extrusion at the molar level (0.2mm) was observed. In conclusion, after proportional condylectomy, a neocondyle forms within 12 months to equal the healthy contralateral side. The articular cavity, which is reduced in the initial stage, increases in size after surgery and the volume gradually approaches that of the healthy side. Dentoalveolar changes occur at the anterior and posterior levels, causing intrusion and extrusion of the interdental crests. An early proportional condylectomy as the sole surgical treatment for patients with AUCH allows normalization of the maxillomandibular relationship.

Temporomandibular arthropathies: A retrospective study with histopathological characteristics.

BackgroundTo investigate the incidence of temporomandibular arthropathies diagnosed in a university center and to describe their histopathological characteristics.Material and MethodsTemporomandibular arthropathy cases with corresponding slides were selected from an oral and maxillofacial surgical pathology service. Cases of exclusively articular disc disease were not included.ResultsThe mean age was 31.3 years with a predominance of females (69.7%). Of these diagnoses, 53.6% were unilateral condylar hyperplasia, 17.8% were bony ankylosis, 14.3% were degenerative joint disease, 10.7% were osteochondroma, and 3.6% were synovial chondromatosis. Condylar hyperplasia presented as thick fibrocartilage and cartilage nests in the cancellous bone. Bony ankylosis exhibited lamellar bone and nests of chondrocytes. Degenerative joint disease presented as an irregular layer of fibrocartilage with areas of clustered chondrocytes and calcified cartilage. Osteochondroma of the condyle exhibited hyaline cartilage and areas of new bone formation. Synovial chondromatosis presented as immature cartilaginous tissue and randomly arranged chondrocytes.ConclusionsThe pathological alterations verified in these arthropathies involved diseases that were predominantly proliferative, i.e., unilateral condylar hyperplasia, osteochondroma and synovial chondromatosis of the tumor or pseudotumor type and bony ankylosis associated with callus formation of the reparative type, and less frequent degenerative changes for which the disease is so named. Key words:Temporomandibular joint, pathology, ankylosis, pathology, arthritis, degenerative, osteochondroma, chondromatosis, synovial.

Facial asymmetry correction: From conventional orthognathic treatment to surgery-first approach.

The surgery-first approach (SFA), which proceeds without presurgical orthodontic treatment, is assumed to shorten the treatment course because the direction of post-surgical orthodontic tooth movement conforms to the normal muscular forces. Moreover, the regional acceleratory phenomenon (RAP), evoked by surgery, helps in tooth alignment and compensation in a faster way. Although SFA has definite advantages, especially in class III individuals, there is a lack of data about its indications in patients with facial asymmetry. In this article, we reviewed recently published articles on the treatment of asymmetric patients using the SFA. Different aspects, including the three-dimensional assessment of stability in different planes, approaches for fabrication of a surgical splint, predictability of the results, skills needed for bimaxillary surgery, indications as the treatment of choice for condylar hyperplasia, and combination with distraction osteogenesis in candidates with severe asymmetries were found to be the main topics discussed for patients presenting with facial asymmetry

Unilateral condylar hyperactivity: histogenetic and patomorphological aspects

Maxillofacial deformations and malocclusions are common pathology that leads to severe functional and aesthetic disturbance. Etiological factors are trauma, genetic disorders, and hormonal imbalance. One of the rare and underexplored forms of congenital growth disorders are hemimandibular growth abnormalities as unilateral condylar hyperactivity, hemifacial elongation, condylar hypoplasia. Unilateral condylar hyperactivity (UCH) is a self-limiting pathology of mandibular condylar bone tissue overgrowth, leading to functional and aesthetic maxillofacial disturbance. The aim of the study was to identify the pathological features of hemimandibular growth abnormalities. We performed diagnostics and treatment of 35 patients (7 male, 28 female) aged from 16 to 37 years with condylar hyper- and hypoplasia. In case of unilateral condylar hyperplasia symptoms we performed high partial condyleectomy as the first step of treatment. In all the patients temporo-mandibular joint function was restored and facial aesthetic was improved as a result of treatment. According to histological features we found the materials from all patients to be divided into two groups: without pronounced continued growth and with signs of enchondral osteohistogenesis. Histological features of the pathological process were detailed in each group.