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Abstract
Condylar hyperplasia is a pathologic condition showing 3-dimensional skeletal hyperplasia of the mandible. The reason for condylar hyperplasia is not yet known, but the effects of hormone, trauma, infection, genetics, fetal condition, and hypervascularity are known as possible reasons. When we diagnose a patient as having condylar hyperplasia, it is important to decide if it is in progress or not. Treatment for facial asymmetry due to condylar hyperplasia are decided accordingly, including condylectomy, that is removal of growth site of the affected condyle, and conventional orthognathic surgery only or condylectomy with orthognathic surgery after the completion of growth. Therefore, it is important to determine the growth state of condylar hyperplasia in treatment stability. This is verified through bone scan and regular check-ups with 3D CT or PA cephalogram. This case report introduces an improved case of facial asymmetry with condylectomy together with orthognathic surgery.
Figures and Tables
Fig 1
Facial and intraoral photographs and panoramic and cephalometric radiographs before treatment.
Fig 2
Cast analysis before treatment. There is a mandibular midline deviation of 12.0 mm to the left side and the mandibular arch is asymmetric.
Fig 3
Bone scan results for case 1. Radio-isotope uptake was increased in the right condylar process area.
Fig 4
Facial and intraoral photographs and panoramic and cephalometric radiographs after condylectomy for case 1.
Fig 5
Posterior-Anterior cephalogram for case 1. A, Before treatment; B, after condylectomy; C, after treatment.
Fig 6
Facial and intraoral photographs and panoramic and cephalometric radiographs after condylectomy for case 1.
Fig 7
Progressive condyle remodeling on panoramic x-ray for case 1. Four months after condylectomy, twelve months after condylectomy there was a continuous cortical layer on the left condyle. Resected condyle was remodeled in the new position.
Fig 8
Facial and intraoral photographs and panoramic and cephalometric radiographs before treatment for case 2.
Fig 9
Cast analysis before treatment for case 2. It shows mandibular midline deviation of 14.0 mm. There is an occlusal canting with the left side more caudal than the right side.
Fig 10
Bone scan results for case 2. Radio-isotope uptake was increased on the left condylar process area.
Fig 11
Facial and intraoral photographs and panoramic and cephalometric radiographs after condylectomy for case 2.
Fig 12
Intraoral photograph for molar intrusion and torque control for case 2. Four miniscrews were inserted to intrude molars on the left maxilla buccal and palatal area and a multi loop was used to add buccal crown torque to the right maxilla area.
Fig 13
Facial and intraoral photographs and panoramic and cephalometric radiographs after treatment for case 2.
Fig 14
Posterior-Anterior cephalogram for case 2. A, Before treatment; B, after condylectomy; C, after treatment.
Fig 15
After condylectomy, resected condyle was remodeled in the new position. After five months, condylar shape is getting smoothly rounded, and twenty six months later, it was remodeled to a normal condylar shape.
Fig 17
Principles of condylar hyperplasia treatment. The most important factor to decide is whether the condyle is growing or not to treat the facial asymmetry due to condylar hyperplasia.
Fig 18
Clinical healing pattern after condylectomy. Straight after condylectomy, there is lateral openbite on the unaffected side. According to the remodeling process, lateral openbite is closed and facial asymmetry is improved.
Fig 19
Superimposition of cephalometric tracing of before treatment and after condylectomy (Red: before treatment, Blue: after condylectomy). Molar was intruded and alveolar area was remodeled on the affected area (left side). But there were no changes in the maxillary basal bone area.
Table 2
PA cephalometric data before and after condylectomy and after treatment for Case 1 (unit: mm)
Horizontal, perpendicular to the line passing through crista galli and ANS, which are passing through crista galli; Vertical, line passing through crista galli and ANS; Mx6cusp-horizontal, distance from maxillary first molar palatal cusp to horizontal line; Jugular pc-horizontal, distance from Jugular process to horizontal line; Ag-horizontal, distance from Ag to horizontal line; Menton-vertical, distance from menton to vertical line; Maxilla width, distance between left and right jugular processes; Mandible width, distance between left and right antegonial notches; Ag, antegonial notch.
Table 4
PA cephalometric data before and after condylectomy and after treatment for case 2 (unit: mm)
Horizontal, perpendicular to the vertical line; Vertical, the line passing through crista galli and ANS; Mx6-cusp-horizontal, distance from maxillary first molar palatal cusp to horizontal line; Jugular pc-horizontal, distance from Jugular process to horizontal line; Aghorizontal, distance from Ag to horizontal line; Menton-vertical, distance from menton to vertical line; Maxilla width, distance between left and right jugular processes; Mandible width, distance between left and right antegonial notches; Ag, antegonial notch.
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