Two-Stage Approach for Treatment of Two Patients with Facial Asymmetry Caused by Unilateral Condylar Hyperplasia

Abstract

Unilateral condylar hyperplasia often causes severe facial asymmetry, malocclusion and temporomandibular joint pain. We present two cases of unilateral condylar hyperplasia with significant facial asymmetry and severe malocclusion. The first case was a 46-year-old female whose complaint was temporomandibular joint pain, facial asymmetry and trismus. The clinical diagnosis was left condylar tumor because these symptoms were recognized in post-adolescence and continued to progress. Low condylectomy with extraction of condylar disk was performed. The pathological diagnosis was condylar hyperplasia. Orthodontic treatment was continued for 5 months after condylectomy, and orthognathic surgery were performed. The second case was a 34-year-old female whose complaint was facial asymmetry and temporomandibular joint pain. These symptoms were recognized in adolescence and progressed slowly. The clinical diagnosis was left condylar hyperplasia. During pre-operative orthodontic treatment, 99mTc scintigram revealed proliferative activity in the left condylar lesion, and resection of the lesion was performed. The residual condyle was trimmed and contoured. Orthodontic treatment was continued for 10 months after the condylar operation, followed by orthognathic surgery. Four years and one year have passed since the orthognathic surgery, and esthetic and functional improvements and patient satisfaction have been obtained in both cases. In cases of facial asymmetry with condylar hyperplasia, it is often difficult to predict the occlusal and esthetic status without the improvement of condylar shape and function.The two-stage approach was a valid procedure to predict and obtain post-operative stability for the jaw and temporomandibular joint deformity.: condylar hyperplasia( 下 顎 頭 過 形 成 ) ， facial asymmetry(顔面非対称) ，orthognathic surgery (顎矯正手術) ［Received Nov. 30, 2015］ 日顎変形誌 Jpn.

Collaborative treatment for a case of condylar hyperplastic facial asymmetry

“…15 The former has an onset before adolescence and Tc-99m hydroxydiphosphonate demonstrates a focal uptake, while the latter has an onset after adolescence with pain and low-intensity uptake on bone scintigraphy. 4 Therefore, the current patient's left condyle was not considered to exhibit an osteochondroma.…”

“…2 Especially in cases with a long-term course in adults, not only mandibular deviation is observed, but also severe vertical dentoalveolar compensation of the upper and lower alveolar bones on the affected side. 3,4 Although condylectomy has been recommended in several case reports as an alternative treatment, [5][6][7] the surgical procedure involves a high risk of postsurgical jaw dysfunction. 8 The establishment of facial symmetry is difficult, even with condylectomy and orthognathic surgery, because the occlusal cant and frontal mandibular deviation do not necessarily match.…”