Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Surgery-early approach combined with condylectomy for correction of severe facial asymmetry with mandibular condylar hyperplasia: a case report

  • Hikari Suzuki (Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry) ;
  • Shinnosuke Nogami (Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry) ;
  • Yoshio Otake (Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry) ;
  • Yuri Takeda (Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry) ;
  • Junji Sugawara (Orthodontist Dr. Junji Sugawara Clinic) ;
  • Tetsu Takahashi (Department of Oral and Maxillofacial Surgery, Southern Tohoku Fukushima Hospital) ;
  • Kensuke Yamauchi (Division of Oral and Maxillofacial Reconstructive Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry)
  • Received : 2024.04.04
  • Accepted : 2024.06.19
  • Published : 2024.08.31
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Abstract

In patients with unilateral mandibular condyle hyperplasia, whether to perform condylectomy and orthognathic surgical procedures at the same time or orthognathic surgery in two stages for remains controversial. Reported here is a case of facial asymmetry with mandibular condyle hyperplasia, for which condylectomy and orthognathic surgery procedures were performed at the same time. A 28-year-old woman was presented to our department with chief complaints of left deviation of the mandible and right temporomandibular joint (TMJ) noise. Findings obtained in several imaging examinations led to a diagnosis of facial asymmetry associated with right mandibular condyle hyperplasia. Following 3 months of preoperative orthodontic treatment, in October 2018 under general anesthesia the patient underwent a right mandibular condylectomy, Le Fort I osteotomy, right mandibular sagittal split ramus osteotomy, and left mandibular inverted L ramus osteotomy. In examinations up to 3 years after surgery, good results were noted. For this case of severe facial asymmetry with mandibular condyle hyperplasia, early surgery and condylectomy were performed simultaneously to significantly shorten the total treatment time. The effectiveness of a surgery-early approach was confirmed by no postoperative findings indicating abnormalities in the TMJ or retroversion.

Keywords

Acknowledgement

A Grant-in-Aid for Young Scientists (No. 22K17149) was given to Y.T. from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

References

  1. Kim SS, Jung KS, Kim YI, Park SB, Kim SH. Unilateral condylar hyperplasia treated with simultaneous 2-jaw orthognathic surgery and posterior segmental osteotomy. Angle Orthod 2022;93:236-52. https://doi.org/10.2319/060122-401.1 
  2. Raijmakers PG, Karssemakers LH, Tuinzing DB. Female predominance and effect of gender on unilateral condylar hyperplasia: a review and meta-analysis. J Oral Maxillofac Surg 2012;70:e72-6. https://doi.org/10.1016/j.joms.2011.05.026 
  3. Almeida LE, Zacharias J, Pierce S. Condylar hyperplasia: an updated review of the literature. Korean J Orthod 2015;45:333-40. https://doi.org/10.4041/kjod.2015.45.6.333 
  4. Mah DH, Kim SG, Oh JS, You JS, Jung SY, Kim WG, et al. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction. J Korean Assoc Oral Maxillofac Surg 2017;43:23-8. https://doi.org/10.5125/jkaoms.2017.43.1.23 
  5. Nagasaka H, Sugawara J, Kawamura H, Nanda R. "Surgery first" skeletal class III correction using the skeletal anchorage system. J Clin Orthod 2009;43:97-105. 
  6. Sugawara J, Aymach Z, Nagasaka DH, Kawamura H, Nanda R. "Surgery first" orthognathics to correct a skeletal class II malocclusion with an impinging bite. J Clin Orthod 2010;44:429-38. 
  7. Wei H, Liu Z, Zang J, Wang X. Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;126:107-16. https://doi.org/10.1016/j.oooo.2018.02.018 
  8. Nitzan DW, Katsnelson A, Bermanis I, Brin I, Casap N. The clinical characteristics of condylar hyperplasia: experience with 61 patients. J Oral Maxillofac Surg 2008;66:312-8. https://doi.org/10.1016/j.joms.2007.08.046 
  9. Villanueva-Alcojol L, Monje F, Gonzalez-Garcia R. Hyperplasia of the mandibular condyle: clinical, histopathologic, and treatment considerations in a series of 36 patients. J Oral Maxillofac Surg 2011;69:447-55. https://doi.org/10.1016/j.joms.2010.04.025 
  10. Olate S, Netto HD, Rodriguez-Chessa J, Alister JP, de Albergaria-Barbosa J, de Moraes M. Mandible condylar hyperplasia: a review of diagnosis and treatment protocol. Int J Clin Exp Med 2013;6:727-37. 
  11. Olate S, Almeida A, Alister JP, Navarro P, Netto HD, de Moraes M. Facial asymmetry and condylar hyperplasia: considerations for diagnosis in 27 consecutives patients. Int J Clin Exp Med 2013;6:937-41. 
  12. Beltran J, Zaror C, Moya MP, Netto HD, Olate S. Diagnosis and treatment in unilateral condylar hyperplasia. J Clin Med 2023;12:1017. https:doi.org/10.3390/jcm12031017 
  13. Martin-Granizo R, Garcia-Rielo JM, De la Sen O, Maniegas L, Berguer A, De Pedro M. Correlation between single photon emission computed tomography and histopathologic findings in condylar hyperplasia of the temporomandibular joint. J Craniomaxillofac Surg 2017;45:839-44. https://doi.org/10.1016/j.jcms.2017.03.004 
  14. Chan BH, Leung YY. SPECT bone scintigraphy for the assessment of condylar growth activity in mandibular asymmetry: is it accurate? Int J Oral Maxillofac Surg 2018;47:470-9. https:doi.org/10.1016/j.ijom.2017.09.008 
  15. Obwegeser HL, Makek MS. Hemimandibular hyperplasia--hemimandibular elongation. J Maxillofac Surg 1986;14:183-208. https://doi.org/10.1016/s0301-0503(86)80290-9 
  16. Goulart DR, Munoz P, Cantin Lopez MG, de Moraes M, Olate S. Comparative evaluation of condylar volume between patients with unilateral condylar hyperplasia and class III dentofacial deformity. J Oral Maxillofac Surg 2017;75:180-8. https://doi.org/10.1016/j.joms.2016.09.002 
  17. Wolford LM, Movahed R, Perez DE. A classification system for conditions causing condylar hyperplasia. J Oral Maxillofac Surg 2014;72:567-95. https://doi.org/10.1016/j.joms.2013.09.002 
  18. Wolford LM. Concomitant temporomandibular joint and orthognathic surgery. J Oral Maxillofac Surg 2003;61:1198-204. https://doi.org/10.1016/s0278-2391(03)00682-7 
  19. Gallagher AL, Ruellas ACO, Benavides E, Soki FN, Aronovich S, Magraw CBL, et al. Mandibular condylar remodeling characteristics after simultaneous condylectomy and orthognathic surgery. Am J Orthod Dentofacial Orthop 2021;160:705-17. https://doi.org/10.1016/j.ajodo.2020.06.040 
  20. Nolte JW, Schreurs R, Karssemakers LHE, Tuinzing DB, Becking AG. Demographic features in unilateral condylar hyperplasia: an overview of 309 asymmetric cases and presentation of an algorithm. J Craniomaxillofac Surg 2018;46:1484-92. https://doi.org/10.1016/j.jcms.2018.06.007