Surgical approach and orthodontic treatment of mandibular condylar osteochondroma

Abstract

Osteochondroma is a common benign tumor of bones, but it is rare in the mandibular condyle. With its outgrowth it manifests clinically as deviation of the mandible limitation of mouth opening, and facial asymmetry. After the tumor is diagnosed on the basis of clinical symptoms and radiographic examination including cone-beam computed tomography (CBCT) analysis, an appropriate surgery and treatment plan should be formulated. Herein, we present the case of a 44-year-old female patient who visited our dental hospital because her chin point had been deviating to the left side slowly but progressively over the last 3 years and she had difficulty masticating. Based on CBCT, she was diagnosed with skeletal Class III malocclusion accompanied by osteochondroma of the right mandibular condyle. Maxillary occlusal cant with the right side down was observed, but it was confirmed to be an extrusion of the molars associated with dental compensation. Therefore, after intrusion of the right molars with the use of temporary anchorage devices, sagittal split ramus osteotomy was used to remove the tumor and perform orthognathic surgery simultaneously. During 6 months after the surgery, continuous bone resorption and remodeling were observed in the condyle of the affected side, which led to a change in occlusion. During the postoperative orthodontic treatment, intrusive force and buccal torque were applied to the molars on the affected side, and a proper buccal overjet was created. After 18 months, CBCT revealed that the rate of bone absorption was continuously reduced, bone corticalization appeared, and good occlusion and a satisfying facial profile were achieved.

A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma

“…Condylectomy or accompanying joint sacrifice and subsequent condylar reconstruction via extraoral incision have been reported in many studies [ 19 – 21 ]. Yet, the conventional preauricular incision has certain disadvantages, including facial nerve injury, articular capsule exposure, and permanent scarring [ 22 ]. Moreover, the treatment of complete condylectomy and subsequent autogenous or alloplastic TMJ reconstruction remains controversial [ 19 , 23 ].…”

Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma

“…The intraoral or extraoral approach have been reported in the treatment of OC [ 15 , 24 , 25 , 26 , 27 ]. Yu, H B [ 23 ] reported the application of an endoscope to treat condylar OC through an intraoral approach, which proved to an effective method of treatment.…”

“…With severe deformity, additional orthognathic correction and orthodontic treatment are needed [ 15 , 16 , 17 ]. Currently, the more consistent view for treating OCs is the excision of the tumor and the maximal preservation of some or all of the condylar head [ 18 ].…”