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Resnick CM. Pediatric Temporomandibular Joint Pathology. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00008-6. [PMID: 38462395 DOI: 10.1016/j.coms.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Pediatric temporomandibular joint (TMJ) disorders represent a broad range of congenital and acquired diagnoses. Dentofacial deformities, including facial asymmetry, retrognathism, and malocclusion, commonly develop. Compared with adult TMJ conditions, pain and articular disc pathology are less common. Accurate diagnosis is paramount in planning and prognostication. Several specific considerations apply in preparation for skeletal correction, including timing in relation to disease progression and growth trajectory, expectation for postcorrection stability, reconstructive technique as it applies to expected durability and need for future revision, management of occlusion, and need for ancillary procedures to optimize correction. This article reviews common conditions and treatment considerations.
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Affiliation(s)
- Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Dhungel D, Rastogi V, Maddheshiya N, Chaurasia S, Ramalingam K. Osteochondroma of the Mandibular Condyle: A Rare Case Presentation With Literature Review. Cureus 2023; 15:e50355. [PMID: 38213345 PMCID: PMC10781615 DOI: 10.7759/cureus.50355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
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.
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Affiliation(s)
- Dilasha Dhungel
- Department of Oral Pathology, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, NPL
| | - Varun Rastogi
- Department of Oral Pathology, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, NPL
| | - Nisha Maddheshiya
- Department of Oral Medicine and Radiology, Faculty of Medical Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Sandhya Chaurasia
- Department of Oral Pathology, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, NPL
| | - Karthikeyan Ramalingam
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Espinosa S, Cortés R, Toro-Ibacache V. Single photon emission computed tomography (SPECT) diagnostic accuracy in active unilateral condylar hyperplasia: Retrospective study. J Craniomaxillofac Surg 2023; 51:467-474. [PMID: 37550116 DOI: 10.1016/j.jcms.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 05/30/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
The aim of this study was to assess the diagnostic accuracy of single photon emission tomography (SPECT) in unilateral condylar hyperplasia (UCH). To this end, 3D morphometric changes of the mandibles in one year were assessed (T0 vs. T1) and compared over SPECT results in T1, in a sample of 40 patients. A contingency table was constructed based on these results for SPECT diagnostic accuracy evaluation, classifying patients as SPECT true-positive, true-negatives, false positives and false-negatives. Additionally, the morphometric analysis was used to describe the presentation of mandibular changes using principal component analysis (PCA) and non-parametric statistics. We obtained diagnostic accuracy results of sensitivity 81%, specificity 63%, positive predictor value (PPV) 59%, negative predictor value (NPV) 83% and accuracy 70%, showing that SPECT yields poor results regarding accuracy diagnostic performance. The morphometric analysis showed that individuals without progress of asymmetry and those with more progress differ particularly in a group of landmarks representing the mental region and the right mandibular body. Based on these landmarks, difference among the four SPECT-accuracy groups was statistically significant (p < 0.001), where the landmark showing the largest change within a year had a mean increase of 1.13 + 0.66 mm. Within the limitations of the study, it seems that SPECT alone is not suitable for making surgical decisions regarding condylectomy in active UCH. Follow up with morphological assessment methods are recommended for confirming an active UCH in combination with SPECT.
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Affiliation(s)
- S Espinosa
- Department of Oral and Maxillofacial Surgery, Hospital Sótero del Río, Santiago, Chile; Department of Oral and Maxillofacial Surgery, Clinica Indisa, Santiago, Chile.
| | - R Cortés
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - V Toro-Ibacache
- Laboratory for Craniofacial Research and Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile; Department of Maxillofacial Surgery, Hospital Clínico San Borja Arriarán, Santiago, Chile
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Si J, Zhang C, Tian M, Jiang T, Zhang L, Yu H, Shi J, Wang X. Intraoral Condylectomy with 3D-Printed Cutting Guide versus with Surgical Navigation: An Accuracy and Effectiveness Comparison. J Clin Med 2023; 12:jcm12113816. [PMID: 37298011 DOI: 10.3390/jcm12113816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/22/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023] Open
Abstract
This study compares the accuracy and effectiveness of our novel 3D-printed titanium cutting guides with intraoperative surgical navigation for performing intraoral condylectomy in patients with mandibular condylar osteochondroma (OC). A total of 21 patients with mandibular condylar OC underwent intraoral condylectomy with either 3D-printed cutting guides (cutting guide group) or with surgical navigation (navigation group). The condylectomy accuracy in the cutting guide group and navigation group was determined by analyzing the three-dimensional (3D) discrepancies between the postoperative computed tomography (CT) images and the preoperative virtual surgical plan (VSP). Moreover, the improvement of the mandibular symmetry in both groups was determined by evaluating the chin deviation, chin rotation and mandibular asymmetry index (AI). The superimposition of the condylar osteotomy area showed that the postoperative results were very close to the VSP in both groups. The mean 3D deviation and maximum 3D deviation between the planned condylectomy and the actual result were 1.20 ± 0.60 mm and 2.36 ± 0.51 mm in the cutting guide group, and 1.33 ± 0.76 mm and 4.27 ± 1.99 mm in the navigation group. Moreover, the facial symmetry was greatly improved in both groups, indicated by significantly decreased chin deviation, chin rotation and AI. In conclusion, our results show that both 3D-printed cutting-guide-assisted and surgical-navigation-assisted methods of intraoral condylectomy have high accuracy and efficiency, while using a cutting guide can generate a relatively higher surgical accuracy. Moreover, our cutting guides exhibit user-friendly features and simplicity, which represents a promising prospect in everyday clinical practice.
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Affiliation(s)
- Jiawen Si
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Chenglong Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Ming Tian
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Tengfei Jiang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Lei Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Jun Shi
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China
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Xia L, Jiang W, Yao K, Wei S, Yu W, Lu X. Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series. J Craniomaxillofac Surg 2023; 51:123-129. [PMID: 36803856 DOI: 10.1016/j.jcms.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/14/2022] [Accepted: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO). Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the "new condyle" and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8-12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the "new condyle" moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved. Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.
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Affiliation(s)
- Liang Xia
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Wenxin Jiang
- Department of Stomatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
| | - Kan Yao
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Silong Wei
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Wenwen Yu
- Department of Oral and Cranio-maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, PR China.
| | - Xiaofeng Lu
- Department of ENT and Oral Maxillofacial Surgery, Shanghai Children Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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Kün-Darbois JD, Bertin H, Mouallem G, Corre P, Delabarde T, Chappard D. Bone characteristics in condylar hyperplasia of the temporomandibular joint: a microcomputed tomography, histology, and Raman microspectrometry study. Int J Oral Maxillofac Surg 2022; 52:543-552. [PMID: 36180268 DOI: 10.1016/j.ijom.2022.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Unilateral condylar hyperplasia (UCH) of the temporomandibular joint is a progressive deformation of the mandibular condyle of unknown origin. UCH is characterized by excessive growth of the condylar head and neck, leading to an increase in size and volume. The aim of this study was to investigate the characteristics of the bone in patients with UCH using microcomputed tomography (micro-CT), histology, and Raman microspectroscopy. The mandibular condyles of six patients with UCH were analysed using micro-CT, histology, and Raman microspectrometry and imaging, and the results were compared with those obtained for a normal control subject. Three-dimensional micro-CT models revealed focal abnormalities of the bone microarchitecture, with foci of osteosclerosis. Histological sections showed that these foci included islands of calcified cartilage matrix with live chondrocytes. Raman analysis revealed that the cartilage matrix was more heavily calcified than the bone matrix and that the cartilage could be identified by the phenylalanine (PHE) band of its matrix, as well as by its glycosaminoglycan (GAG) content. The persistence of foci of live and active chondrocytes within the bone matrix is intriguing and appears to be pathognomonic of UCH. These new findings on UCH could help to determine its pathophysiology and thus prevent this disease, which can lead to major facial deformity.
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Affiliation(s)
- J-D Kün-Darbois
- Université Angers, GEROM, IRIS-IBS Institut de Biologie en Santé, Angers, France; Service de Chirurgie Maxillo-faciale et Stomatologie, CHU d'Angers, Angers, France; Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France
| | - H Bertin
- Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Nantes, Nantes, France; Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France
| | - G Mouallem
- Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Nantes, Nantes, France
| | - P Corre
- Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Nantes, Nantes, France; Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France
| | - T Delabarde
- Institut Médico-Légal de Paris, Paris, France
| | - D Chappard
- Université Angers, GEROM, IRIS-IBS Institut de Biologie en Santé, Angers, France; Univ Angers, Nantes Université, Oniris, Inserm, RMeS, REGOS, SFR ICAT, F-49000 Angers, France.
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Mahmood Hashemi H, Amirzargar R. Can electrocautery of the mandibular condyle effectively treat condylar hyperplasia? J Craniomaxillofac Surg 2022; 50:S1010-5182(22)00088-9. [PMID: 36207204 DOI: 10.1016/j.jcms.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 10/15/2022] Open
Abstract
This study aims to introduce and evaluate a novel technique to treat unilateral condylar hyperplasia (UCH) by electrocauterization of the mandibular condyle via an intraoral approach. Patients suffering from unilateral condylar hyperplasia (UCH) were included in this study. All patients underwent electrocauterization of the affected condyle. An intraoral incision on the anterior border of the mandibular ramus was made to expose the external surface of the ramus and access the anterior border of the condylar head. A hole was then drilled into the condyle and cauterization was performed; six patients also received orthognathic surgery during the procedure. Patients underwent careful clinical assessment and radiological evaluation including panoramic view, lateral and posteroanterior cephalometry, cone-beam computed tomography (CBCT) and scintigraphy to assess condylar growth for a period of 12-24 months. Ten patients (5 male and 5 female) with active UCH type 1B or 2A were included in this study with a mean age of 20.7 years (range, 18-21.7 years). At the 12-month postoperative assessment, clinical evaluation showed stable dental occlusion with no midline shift; scintigraphy showed persistently reduced cellular activity, and computed tomography scans revealed no degeneration in either of the condyles with complete healing of the drilled holes. Within the limitations of this study it seems that the proposed treatment approach might be an alternative to previously established protocols.
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Affiliation(s)
- Hamid Mahmood Hashemi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Amirzargar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study. Symmetry (Basel) 2022. [DOI: 10.3390/sym14071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hemimandibular hyperplasia (HH) and elongation (HE) are the most common pathologies present in the mandible. Presented condylar hyperplasias have their own radiological and clinical features. In most cases, patients suffer from various forms of malocclusion. From a total of 150 asymmetrical jaw radiographs evaluated, 46 were evaluated and included in this study. A retrospective study on the data of 46 selected patients treated, diagnosed, and consulted from various forms of mandibular and skeletal asymmetry based on routine diagnostic panoramic radiographs evaluated typical and atypical radiological and anatomical symptoms of condylar hyperplasia. The presented evaluation focused on mandibular, maxillary, and other bones, in order to distinguish condylar hyperplasia from other forms of mandibular asymmetry. The degree of maxillary downward growth followed by the occurrence of an open bite on the affected side estimate the degree/presence or cessation of growth in the affected condyle. Mandibular asymmetry with incisor teeth inclination remains the most typical characteristic of condylar hyperplasia. Increased height of mandibular ramus differentiates between condylar hyperplasia and elongation, which also influences the position of the inferior alveolar nerve. Mentioned symptoms, described as the acronym “Go Moira!”, are useful in a quick and simple “glimpse of an eye” differential diagnostic approach. It is possible to quickly and accurately establish the first diagnosis simply by a careful evaluation of patients’ panoramic radiographs.
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Mallya SM, Ahmad M, Cohen JR, Kaspo G, Ramesh A. Recommendations for imaging of the temporomandibular joint. Position statement from the American Academy of Oral and Maxillofacial Radiology (AAOMR) and the American Academy of Orofacial Pain (AAOP). Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:639-648. [DOI: 10.1016/j.oooo.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
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Laguna-Monagas HA, Hernández-Andara A, Ortega-Pertuz A, Cordsen H, Gudiño R, Contreras C. [Clinical and imagenological evaluation of the temporomandibular joint in patients undergoing condylectomy for the treatment of unilateral hyperplasia. Case series study]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e090. [PMID: 38463722 PMCID: PMC10919808 DOI: 10.21142/2523-2754-0904-2021-090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/13/2021] [Indexed: 03/12/2024] Open
Abstract
Unilateral condylar hyperplasia is a non-neoplastic and self-limiting overgrowth of the mandibular condyle that usually begins during puberty, predominates in women and is considered an aberration of the normal growth mechanism of the condyle. This abnormal growth continues until the mid-20s and produces mandibular prognostism, facial and occlusal asymmetry with progressive displacement of the mandible to the contralateral side. The purpose of this report was to describe the cases of two female patients (23 and 25 years old) with unilateral condylar hyperplasia treated with high condylectomy and orthognathic surgery, with emphasis on clinical and imaging aspects and late post-surgical follow-up. Both patients presented satisfactory cosmetic results, without pain / noise related to the temporomandibular joint, mouth opening within the normal range, and class I canine and molar relationship. Computed tomography showed signs of remodeling in the affected condyle. High condylectomy combined with orthognathic surgery is an adequate treatment in cases of unilateral hyperplasia, restoring functionality and aesthetics to the patient. The bone remodeling observed in the intervened condyles seems to indicate that the condylar head maintains its adaptive capacity even in adult patients.
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Affiliation(s)
- Héctor Andrés Laguna-Monagas
- Programa de Cirugía y Traumatología Bucal y Maxilofacial, Hospital General del Oeste Doctor José Gregorio Hernández. Caracas, Venezuela. Programa de Cirugía y Traumatología Bucal y Maxilofacial Hospital General del Oeste Doctor José Gregorio Hernández Caracas Venezuela
| | - Adalsa Hernández-Andara
- Unidad de Diagnóstico por Imagen, Clínica Félix Boada. Caracas, Venezuela. Unidad de Diagnóstico por Imagen Clínica Félix Boada Caracas Venezuela
| | - Ana Ortega-Pertuz
- Instituto de Investigaciones, Facultad de Odontología de la Universidad del Zulia. Maracaibo, Venezuela. Universidad del Zulia Instituto de Investigaciones Facultad de Odontología de la Universidad del Zulia Maracaibo Venezuela
| | - Hans Cordsen
- Servicio de Cirugía Maxilofacial, Hospital General del Oeste Doctor José Gregorio Hernández. Caracas, Venezuela. , , Servicio de Cirugía Maxilofacial Hospital General del Oeste Doctor José Gregorio Hernández Caracas Venezuela
| | - Ronar Gudiño
- Servicio de Cirugía Maxilofacial, Hospital General del Oeste Doctor José Gregorio Hernández. Caracas, Venezuela. , , Servicio de Cirugía Maxilofacial Hospital General del Oeste Doctor José Gregorio Hernández Caracas Venezuela
| | - Carlos Contreras
- Servicio de Cirugía Maxilofacial, Hospital General del Oeste Doctor José Gregorio Hernández. Caracas, Venezuela. , , Servicio de Cirugía Maxilofacial Hospital General del Oeste Doctor José Gregorio Hernández Caracas Venezuela
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Lentzen MP, Riekert M, Grozinger P, Zirk M, Nickenig HJ, Zöller JE, Kreppel M. Anatomical and volumetric analysis of fibro-osseous lesions of the craniofacial skeleton. J Craniomaxillofac Surg 2021; 49:1113-1118. [PMID: 34563422 DOI: 10.1016/j.jcms.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Our study aimed to provide volumetric data relating to fibro-osseous lesions of the craniofacial skeleton, in order to highlight risk factors due to the different entities, and to guide clinical decisions for jeopardized patients. METHODS Volumetric measurements of osteomas and ossifying fibromas were performed by applying the open-source software ITK-Snap to cone-beam computed tomography images. DICOM datasets were imported, identified, and delineated using semiautomatic segmentation; this was then verified using manual segmentation. The volumes of the lesions were computed automatically in cubic millimeters using the program. For statistical investigations, descriptive statistics and independent Student t-tests were performed. Additionally, Pearson's correlation was applied as a bivariate analysis. Values of p < 0.05 were considered significant. RESULTS 45 patients (11 male and 34 female) were included in this study. The mean volumes were 10.02 ± 18.79 cm3 for osteomas and 4.80 ± 5.71 cm3 for ossifying fibromas (p = 0.016). Males (12.81 ± 20.38 cm3) presented significantly larger volumes than females (5.43 ± 10.32 cm3) (p = 0.042). With regard to shape, morphology, and affection of surrounding anatomical structures, irregular shape (p = 0.001; p = 0.037), multilocular morphology (p = 0.001; p = 0.037), nerve affection (p = 0.001; p = 0.002), tooth affection (p = 0.001; p = 0.594), cortical bone exceedance (p = 0.033; p = 0.001), and clinically visible symptoms (p = 0.004; p = 0.001) were statistically significantly associated with a larger volume of both entities. CONCLUSION Volumetric analysis revealed that osteomas significantly exceeded the mean size of ossifying fibromas, supporting the argument that special attention should be paid to this entity. In cases of difficult histopathological examination, lesions with irregular shape, multilocular morphology, nerve and tooth affection, cortical bone exceedance, and clinically visible symptoms should be considered for close clinico-radiological follow-up, irrespective of the entity.
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Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany.
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Philipp Grozinger
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
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Gerbino G, Segura-Pallerès I, Ramieri G. Osteochondroma of the mandibular condyle: Indications for different surgical methods: A case series of 7 patients. J Craniomaxillofac Surg 2021; 49:584-591. [PMID: 33994297 DOI: 10.1016/j.jcms.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to evaluate and discuss the long-term outcomes of patients with condylar osteochondroma managed through 3 different surgical techniques. Seven patients with condylar osteochondroma treated in the author's department from May 2012 to January 2019 were included in this retrospective study. Clinical evaluations (visual analogue scale for TMJ pain, jaw function, symmetry, and quality of life), maximum interincisal opening (MIO) and radiological findings were collected pre- and postoperatively. Other parameters assessed included tumour size and location; complications and follow-up. Radical condylectomy with immediate total joint alloplastic reconstruction was performed in 4 patients, local excision in 2 patients and low condylectomy with concomitant orthognathic surgery in 1 patient. During an average follow-up period of 40,8 months no clinical or radiographic signs of recurrence were found. Average MIO increased from 25,5mm to 39,5mm at the longest follow up, and all clinical evaluations were greatly improved. In conclusion, the described surgical techniques appear valuable in the treatment of condylar osteochondroma. Local excision is indicated in tumor involving less than half the surface of the condylar head; radical condylectomy with immediate alloplastic total joint reconstruction is indicated in gigantic lesion compromising the anatomical components and function of the joint. Orthognathic surgery procedures should be combined with tumor resection when correction of associated dentofacial deformities is indicated.
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Affiliation(s)
- Giovanni Gerbino
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy
| | - Ignasi Segura-Pallerès
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy
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Choi JW, Park H, Kwon SM, Lee JY. Surgery-first orthognathic approach for the correction of facial asymmetry. J Craniomaxillofac Surg 2021; 49:435-442. [PMID: 33934974 DOI: 10.1016/j.jcms.2021.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/02/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
We aimed to compare the reliability of the surgery-first approach and the traditional orthodontic-first approach for the correction of facial asymmetry based on the new classification of facial asymmetry. Patients with facial asymmetry who underwent orthognathic surgery between January 2016 and January 2019 were included. Cephalometric changes and relapse ratios were analyzed 12 months before and after surgery. Patients were divided into horizontal and vertical asymmetry groups based on the asymmetry vector, and subgroup analysis was conducted. The surgery-first approach without presurgical orthodontic treatment and the orthodontic-first approach showed a similar degree of asymmetry correction and skeletal stability. The relapse ratios of the maxilla height in the surgery-first and orthodontic-first groups were 0.25 ± 0.21 and 0.27 ± 0.25, respectively (p = 0.63), the relapse ratios of the maxilla width were 0.31 ± 0.32 and 0.21 ± 0.2, respectively (p = 0.14), the mandibular height relapse ratios were 0.34 ± 0.58 and 0.29 ± 0.36, respectively (p = 0.69), and the mandibular width relapse ratios were 0.12 ± 0.22 and 0.26 ± 0.31, respectively (p = 0.058). The treatment period of the surgery-first group (18.5 ± 5.3 months) was significantly shorter than that of the orthodontic-first group (22.9 ± 7.5 months, p = 0.024). Among the surgery-first group, patients with vertical asymmetry (15.0 ± 3.2 months) had a shorter treatment than those with horizontal asymmetry (21.6 ± 6.8 months, p = 0.006). Although contesting traditional standards is always challenging, the surgery-first orthognathic approach may lead to a new era in traditional orthognathic approaches. This new classification of facial asymmetry could be useful and practical when treating patients with facial asymmetry regardless of the etiology.
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Affiliation(s)
- Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea.
| | - Hojin Park
- Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
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Chen YF, Vinayahalingam S, Bergé S, Liao YF, Maal T, Xi T. Three-Dimensional Analysis of the Condylar Hypoplasia and Facial Asymmetry in Craniofacial Microsomia Using Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2021; 79:1750.e1-1750.e10. [PMID: 33939960 DOI: 10.1016/j.joms.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the condylar hypoplasia and its correlation with craniofacial deformities in adults with unilateral craniofacial microsomia (CFM). METHODS Pretreatment cone-beam computed tomography scans of consecutive adults (mean age: 20.4 ± 3.0 years; range: 17.3 to 31.4 years) with Pruzansky-Kaban type I and IIA CFM were reconstructed in 3D. Both condyles were segmented. Asymmetry ratios (affected side/contralateral side) of condylar volume were calculated to indicate the extent of condylar hypoplasia. 3D cephalometry was performed to quantify the maxillomandibular morphology and facial asymmetry. The correlations in between were assessed by using Pearson's or Spearman's correlation coefficients. RESULTS Thirty-six subjects were enrolled, consisting of 22 subjects with Pruzansky-Kaban type I and 14 subjects with type IIA. The condyles in type IIA group were significantly more hypoplastic in height (asymmetry ratio: 40.69 vs 59.95%, P = .006) and volume (18.16 vs 47.84%, P < .001) compared to type I group. Type IIA group had a significantly smaller SNB value than type I group (72.94° vs 77.41°, P = .012), and a significantly greater facial asymmetry (P < .05). The hypoplastic extent of condylar volume and Pruzansky-Kaban types were significantly correlated with SNB (r = 0.457 and ρ = -0.411, respectively), upper incisor deviation (r = -0.446 and ρ = 0.362), chin deviation (r = -0.477 and ρ = 0.527), upper occlusal plane cant (r = -0.672 and ρ = 0.631), and mandibular plane cant (r = -0.557 and ρ = 0.357, P < .05). CONCLUSION For unilateral CFM adults, greater condylar hypoplasia in volume along with more severe mandibular retrusion and facial asymmetry objectively indicated a higher scale of Pruzansky-Kaban classification (type IIA). These quantitative distinctions are expected to enhance the diagnostic reliability of CFM.
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Affiliation(s)
- Yun-Fang Chen
- Assistant Professor, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shankeeth Vinayahalingam
- PhD candidate, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefaan Bergé
- Professor, Department head, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yu-Fang Liao
- Professor, Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan; Professor, Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan
| | - Thomas Maal
- Professor, Director, Radboudumc 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tong Xi
- Surgeon, Research coordinator, Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
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Abotaleb B, Bi R, Telha W, Zhao W, Li Y, Zhu S. Treatment measures of hemimandibular hyperplasia and associated facial deformities. J Craniomaxillofac Surg 2020; 49:126-134. [PMID: 33451941 DOI: 10.1016/j.jcms.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/17/2020] [Accepted: 12/25/2020] [Indexed: 02/05/2023] Open
Abstract
This study aims to show our institute's experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults. The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer. Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13-34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of -144. 80 mm3 (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm3 (p = .881). One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.
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Affiliation(s)
- Bassam Abotaleb
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen.
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wael Telha
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wenli Zhao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yunfeng Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Head of the Department of Orthognathic and TMJ Surgery, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Iwanaga J, Matsushita Y, Decater T, Ibaragi S, Tubbs RS. Mandibular canal vs. inferior alveolar canal: Evidence‐based terminology analysis. Clin Anat 2020; 34:209-217. [DOI: 10.1002/ca.23648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Dental and Oral Medical Center Kurume University School of Medicine Kurume Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy Kurume University School of Medicine Kurume Japan
| | - Yuki Matsushita
- School of Dentistry University of Michigan Ann Arbor Michigan USA
- Department of Clinical Oral Oncology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tess Decater
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Anatomical Sciences St. George's University St. George's Grenada
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Anatomical Sciences St. George's University St. George's Grenada
- Department of Structural and Cellular Biology Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System New Orleans Louisiana USA
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