Low condylectomy and orthognathic surgery to treat mandibular condylar osteochondroma: a retrospective review of 37 cases.

Abstract

PURPOSE:

To evaluate the outcomes from surgical treatment of mandibular condylar osteochondroma (condylar hyperplasia [CH] type 2) using a specific surgical protocol. CH type 2 is a unilateral benign pathologic condition, with progressive proliferation of osseous and cartilaginous tissues in the condylar head. This causes condylar enlargement, often with exophytic growth, resulting in significant facial deformity, pain, and masticatory and occlusal dysfunction.

PATIENTS AND METHODS:

This was a retrospective cohort study of 37 patients (28 females and 9 males), with an average age of 26.3 years (range 13 to 48), with CH type 2, and associated dentofacial deformity. The condylar pathologic features were confirmed by histologic analysis. All patients were treated with low condylectomy, recontouring of the condylar neck to form a new condyle, repositioning of the articular disc over the condylar stump and repositioning of the contralateral disc, if displaced, and any indicated orthognathic surgical procedures. Postoperative follow-up averaged 48 months (range 12 to 288). Patients were assessed preoperatively and at the longest follow-up point for incisal opening, lateral excursions, pain, jaw function, diet, disability, and occlusal and skeletal stability. The pre- and postoperative assessments were compared using paired t test.

RESULTS:

At the longest follow-up point, a nonsignificant decrease (2.3 mm) was seen in the maximum incisal opening; however, the excursive movements had decreased significantly an average of 2.5 mm on the right and 2.2 mm on the left. A statistically significant improvement was seen in pain, jaw function, diet, and disability. A stable Class I skeletal and occlusal relationship was maintained in 34 of the 37 patients (92%). Two patients developed relatively minor postoperative malocclusions that were managed with orthodontics. In 1 patient, a high condylectomy was performed, and the tumor continued to grow, causing malocclusion and jaw deformity to recur. A low condylectomy and sagittal split were performed 14 months later, with a stable result at 4 years after surgery.

CONCLUSIONS:

The results of the present study have demonstrated that a low condylectomy procedure with recontouring of the condylar neck to function as a condyle and repositioning of the articular discs, combined with orthognathic surgery, is a viable option for the treatment of osteochondroma of the mandibular condyle and associated jaw deformity.

• Authors: Larry M Wolford, Reza Movahed, Amit Dhameja, Will R Allen
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 72 Issue 9 Pg. 1704-28 (Sep 2014) ISSN: 1531-5053 [Electronic] United States
• PMID: 24997022 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Cartilage, Articular (surgery)
• Cohort Studies
• Dental Occlusion
• Diet
• Facial Asymmetry (surgery)
• Facial Pain (etiology)
• Female
• Follow-Up Studies
• Humans
• Hyperplasia
• Male
• Malocclusion (etiology)
• Mandibular Condyle (pathology, surgery)
• Mandibular Neoplasms (surgery)
• Middle Aged
• Neoplasm Recurrence, Local (diagnosis)
• Orthognathic Surgical Procedures (methods)
• Osteochondroma (surgery)
• Quality of Life
• Range of Motion, Articular (physiology)
• Retrospective Studies
• Temporomandibular Joint Disc (surgery)
• Treatment Outcome
• Young Adult