Osteochondroma of Mandibular Ramus and Condylar Neck: Simultaneous Resection and Reconstruccion with Personalized Alloplastic Joint Prosthesis

Abstract

Osteochondromas are benign osteogenic tumors that can attain great size, which may require resection and additional treatment to restore the jaw's shape and function. In this report, an osteochondroma located on the mandibular ramus and neck of the condyle was resected and reconstructed simultaneously through a total joint replacement. After the surgery, the patient remains asymptomatic and recovers opening and closing ranges, phonation and the masticatory function. The immediate reconstruction after resection is a good alternative to avoid a second operation and the presurgical virtual planning ensures the complete removal of the lesion using cutting guides and covering the entire defect with a customized alloplastic joint prosthesis.

Total Joint Replacement for Immediate Reconstruction following Ablative Surgery for Primary Tumors of the Temporo-Mandibular Joint

“…While the diagnosis and surgical aims of severe tumoral cases are straight forward, when it comes to initial cases, the diagnosis is often complicated, and the surgical perspective is less clearly defined, especially when TMJ disease progression is slow. However, it can ultimately lead to end-stage TMJ disease with, as a consequence, significant disability requiring surgical intervention, as occurs in patients of this study [3,7,8,10,12,13,[15][16][17][19][20][21][22][23][28][29][30].…”

“…The quantification of implant failures is a determining factor with prognostic value, enabling the clinician to objectively quantify the success of the surgical treatment [3,7,8,10,12,13,[15][16][17][19][20][21][22][23]. Although there were complications necessitating the removal of the prosthesis (2 out of 24 prostheses: 8% of our studied population), there were no device-related mechanical failures; and one case of TMJ prosthesis was explanted due to malocclusion, which was a result of loosening of the implant screws.…”

“…In our cases, osteochondroma was suspected given the clinical characteristics of the lesion. The changes in occlusion with unilateral posterior open bite and contralateral crossbite were related to the anatomical location of the tumor and were due to the alteration of the vertical dimension [4][5][6][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

“…There is little literature available on their characteristics and outcomes; thus, experience in the treatment of tumors and tumoral lesions in this anatomical area is limited. There are several types of tumors that can affect the TMJ, as any other joint, including benign tumors, such as osteochondroma (Figures 1-3), osteoma, osteoblastoma, chondroma, chondroblastoma, non-ossifying fibroma, hemangioma or lipoma, as well as malignant tumors such as synovial sarcoma, osteosarcoma, Ewing sarcoma or chondrosarcoma (Figure 4) [1,2,5,9,11,[21][22][23][24][25][26][27][28][29][30][31]. The wide variety of primary tumors of the TMJ indicates the great range of possible treatments, with most of them based on surgical intervention (Table 2).…”

“…For this reason, a high index of suspicion is needed for the timely diagnosis and management of tumors at this rare site. This may lead to earlier intervention and may improve outcome [3][4][5][7][8][9][10][12][13][14][15]21,23,27]. In some patients, benign tumors of the TMJ remain as totally asymptomatic lesions.…”