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Background: Patients with unilateral condylar hyperplasia (UCH) may present with TMJ symptoms, rather than concerns or recognition of asymmetry. Localization of TMJ pain may be on the affected (long) side, unaffected side, or both. Flattening, severe erosion and internal derangement on the opposite side can be appreciated radiologically. This can be a red herring, shielding the true diagnosis of UCH from the contralateral side. We hypothesize that excessive growth of the ipsilateral condylar neck and head on the side of UCH results in an upward and backward force on the opposite side TMJ, with resultant symptoms and findings (condylar flattening, anterior disk displacement, eminence changes). The purpose of this paper is to highlight the bilateral TMJ findings in UCH, and address potential treatment strategies. Methods: This is a retrospective study involving radiologic and biographical data from subjects with TMJ UCH, as well as controls. Patient details and high quality Cone beam CT (CBCT) scans (1 mm slices or less) were analyzed. CT scans were digitized and morphometric points were placed using Planmeca software (Hoffman Estates, Illinois). Linear and volumetric measures were taken in reference to the eminence, TMJ space, condylar position, and neck lengths. Volumetric analysis of the condylar head and neck was done using Analyze 14.0 software (Overland Park, KS, USA). Results were assessed using univariate analysis (T-Wilcoxon test). Results: Forty patients were included (29 with UCH, 11 controls). The condylar head was flatter and erosive appearing on the contralateral UCH side compared to both ipsilateral side in the same subject, and compared to controls. Analysis between the affected and unaffected sides in patients with UCH showed a significant difference in condylar head and neck length (P =.0019) and volume (P =.0030); anterior glenoid space (P =.035) and vertical height of condylar eminence (P =.00044). The difference in ramus length was not significant (P =.6533). Between the controls and the UCH patients, there was a significant difference in the variance in condylar head and neck length (P = 1.98e-07) and volume between the 2 sides (P = 1.94e-08) but not ramus length (P = 1). The vertical height of the condylar eminence was smaller on the affected side than in the controls (P =.0018) and the anterior glenoid space was significantly smaller on the unaffected side compared to the controls (P =.0053). Conclusion: This study highlights TMJ morphological differences in patients with UCH. These differences in condylar and glenoid morphology are consistent and should be used to aid and underpin the diagnosis and direct treatment. Importantly, patients who present with TMJ pain and erosion on one side, should be assessed for opposite side UCH, as the underlying culprit. [ABSTRACT FROM AUTHOR]

Abstract Background Unilateral condylar hyperplasia (UCH) of the mandible is a rare condition characterized by asymmetric growth of the mandibular condyles. Bone scintigraphy with SPECT(/CT) is commonly used to diagnose UCH and guide treatment. Still, varying results have been reported using the traditional threshold of 55%:45% in relative tracer uptake. While absolute quantification of uptake on SPECT/CT could improve results, optimal correction and reconstruction settings are currently unknown. Methods Three anthropomorphic phantoms representing UCH were developed from patient CT volumes and produced using 3D printing technology. Fillable spherical inserts of different sizes (Ø: 8–15 mm) were placed in the condylar positions representing symmetrical and asymmetrical distributions. Recovery coefficients were determined for SPECT/CT using various reconstruction corrections, including attenuation and scatter correction (ACSC), resolution modeling (RM), and partial volume correction (PVC) using phantom measurements. Uptake ratios between condyles and condyle to clivus were evaluated. Finally, the impact of these correction techniques on absolute activity and diagnostic accuracy was assessed in a retrospective patient cohort for the diagnostic threshold of 55%:45%. Results The activity was only partially recovered in all spherical inserts (range: 22.5–64.9%). However, RM improved relative recovery by 20.2–62.3% compared to ACSC. In the symmetric phantoms, the 95% confidence interval (CI) of condyle ratios included the diagnostic threshold (57.6%:42.4%) for UCH when using ACSC potentially leading to false positives, but not for ACSCRM datasets. Partial volume corrections coefficients from the NEMA IQ phantom was positionally dependent, with improvements seen performing PVC using coefficients derived from anthropomorphic phantoms. Retrospective application in a patient cohort showed only a weak linear correlation (R²: 0.25–0.67) and large limits of agreement (9.6–12.5%) between different reconstructions. Up to 44% of patients were reclassified using the 55%:45% threshold. Using clinical outcome data, ACSCRM had highest sensitivity (91%; 95% CI 59–100%) and specificity (66%; 95% CI 47–81%), significantly improving specificity (P = 0.038). Conclusions Anthropomorphic phantoms were shown to be essential in determining optimal settings for acquisition, reconstruction, and analysis. SPECT/CT reconstructions with attenuation and scatter correction and resolution modeling are recommended and could improve specificity when using the 55%:45% threshold to assess condylar growth.

Objectives: To assess the skeletal and dental maxillary transverse compensation (yaw) on the cone beam computed tomography (CBCT) three‐dimensional reconstructed image of the skull in two groups of patients, both clinically affected by a class III malocclusion with deviation of the lower midline. Materials and Methods: An observational retrospective study was designed to analyse differences in two groups of patients, the first one was composed by patients affected by horizontal condylar hyperplasia, the second one by patients affected by dento‐skeletal asymmetric class III malocclusion. Each group was composed by 15 patients. Transverse analysis was performed by measuring five landmarks (three bilateral and two uneven) with respect to a mid‐sagittal plane; sagittal analysis was performed by measuring the sagittal distance on the mid‐sagittal plane between bilateral points. Means were compared through inferential analysis. Results: In the condylar hyperplasia group, all differences between the two sides were not statistically significant, nor for canines' difference (P =.0817), for molars (P =.1105) or for jugular points (.05871). In the class III group, the differences between the two sides were statistically significant for molars (P =.0019) and jugular points (P =.0031) but not for canines (P =.1158). Comparing the two groups, significant differences were found only for incisors' midline deviation (P =.0343) and canine (P =.0177). Conclusion: The study of the yaw on CBCT should be integrated into three‐dimensional cephalometry and could help in differentiating the various malocclusion patterns. [ABSTRACT FROM AUTHOR]

Abstract Background The research aimed to evaluate the optimal Single-Photon Emission Computed Tomography (SPECT) cut-off value in differentiating condylar growth activeness, to observe 3-dimensional (3D) mandibular growth pattern, and to explore the potential correlation between 3D measurement parameters and SPECT uptake ratios in Chinese unilateral condylar hyperplasia (UCH) patients. Methods Data of fifty-four Chinese UCH patients were analyzed retrospectively. All patients underwent SPECT within 1 month before or after the first CT examination (CT1); and received a second CT examination at least 12 months later (CT2). Data from CT scans were analyzed by comparing bilateral differences between CT1 and CT2. The sensitivity and specificity of SPECT were calculated by the receiver operating characteristic (ROC) curve. Pearson’s correlation analysis was performed to investigate whether the mandibular growth was correlated with SPECT value. Results SPECT had a sensitivity of 68.00% and a specificity of 72.41%, with an area under the ROC curve being 0.709. The optimal SPECT cut-off value for evaluating condylar activity has been determined to be 13%. In patients with an active growing condyle, there was a significant increase in Co-Gn and Co-Go, but not in Go-Gn, Go-MF, or MF-Gn. Pearson’s correlation analysis revealed no correlation between 3D measurement parameters and differences in relative condylar uptake ratios. Conclusion SPECT showed good diagnostic performance in UCH with the cut-off value of 13%. For those with an active growing condyle, the mandible grows diagonally and vertically, while the relative condylar uptake ratio was not directly related to mandibular growth.

Background: The research aimed to evaluate the optimal Single-Photon Emission Computed Tomography (SPECT) cut-off value in differentiating condylar growth activeness, to observe 3-dimensional (3D) mandibular growth pattern, and to explore the potential correlation between 3D measurement parameters and SPECT uptake ratios in Chinese unilateral condylar hyperplasia (UCH) patients. Methods: Data of fifty-four Chinese UCH patients were analyzed retrospectively. All patients underwent SPECT within 1 month before or after the first CT examination (CT1); and received a second CT examination at least 12 months later (CT2). Data from CT scans were analyzed by comparing bilateral differences between CT1 and CT2. The sensitivity and specificity of SPECT were calculated by the receiver operating characteristic (ROC) curve. Pearson's correlation analysis was performed to investigate whether the mandibular growth was correlated with SPECT value. Results: SPECT had a sensitivity of 68.00% and a specificity of 72.41%, with an area under the ROC curve being 0.709. The optimal SPECT cut-off value for evaluating condylar activity has been determined to be 13%. In patients with an active growing condyle, there was a significant increase in Co-Gn and Co-Go, but not in Go-Gn, Go-MF, or MF-Gn. Pearson's correlation analysis revealed no correlation between 3D measurement parameters and differences in relative condylar uptake ratios. Conclusion: SPECT showed good diagnostic performance in UCH with the cut-off value of 13%. For those with an active growing condyle, the mandible grows diagonally and vertically, while the relative condylar uptake ratio was not directly related to mandibular growth. [ABSTRACT FROM AUTHOR]

Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a rare disease. The aim of this study was to evaluate the clinical conditions of progressive facial asymmetry in young subjects treated with high condylectomy. A retrospective study was performed including nine subjects diagnosed with UCH type 1B and progressive facial asymmetry around 12 years old with an upper canine progressing towards dental occlusion. After an analysis and a decision of treatment, orthodontics began one to two weeks prior to the condylectomy (with a mean vertical reduction of 4.83 ± 0.44 mm). Facial and dental asymmetry, dental occlusion, TMJ status and an open/closing mouth were analyzed before surgery and in the final stage of treatment, almost 3 years after surgery. Statistical analyses were performed using the Shapiro–Wilk test and a Student's t-test considering a p value of <0.05. Comparing T1 (before surgery) and T2 (once orthodontic treatment was finalized), the operated condyle showed a similar height to that observed in stage 1 with a 0.12 mm difference in height (p = 0.8), whereas the non-operated condyle showed greater height increase with an average of 3.88 mm of vertical growth (p = 0.0001). This indicated that the non-operated condyle remained steady and that the operative condyle did not register significant growth. In terms of facial asymmetry in the preoperative stage, a chin deviation of 7.55 mm (±2.57 mm) was observed; in the final stage, there was a significant reduction in the chin deviation with an average of 1.55 mm (±1.26 mm) (p = 0.0001). Given the small number of patients in the sample, we can conclude that high condylectomy (approx. 5 mm), if performed early, especially in the mixed-dentition stage before full canine eruption, is beneficial for the early resolution of asymmetry and thus the avoidance of future orthognathic surgery. However, further follow-up until the end of facial growth is required. [ABSTRACT FROM AUTHOR]

A 25-year-old woman presented with left condylar hyperplasia, canting-type facial asymmetry, mandibular prognathism, and arch width discrepancy. Bone scintigraphy confirmed the inactive status of the condyle, and the temporomandibular joint functioned within the normal range; thus, orthognathic surgery without condylectomy was performed. To correct facial asymmetry successfully through orthognathic surgery, sufficient dentoalveolar decompensation must be achieved in the presurgical orthodontic phase. In cases of canting-type facial asymmetry, teeth on the nondeviated side are extruded as dentoalveolar compensation. Therefore, vertical decompensation is required for intrusion of the extruded teeth. A miniscrew and resin build-ups were used for the intrusion of teeth, and posterior segmental osteotomy was simultaneously performed with orthognathic surgery for further intrusion. The canting-type facial asymmetry was notably corrected through successful vertical decompensation and close cooperation between orthodontists and maxillofacial surgeons. After 2 years of retention, the treatment results remained stable. [ABSTRACT FROM AUTHOR]

The following paper focuses on the topic of mandibular unilateral condyle hyperplasia (UCH). This form of mandibular asymmetry (MA) is one of the less common but still known pathologies that requires detailed surgical and orthodontic planning and treatment. Since this pathology is mostly related to a high number of individual dental, bone, and overgrowth factors, until now the treatment methods were individually driven. It seems that the scope of surgical intervention is greatly dependent on the degree of bone overgrowth and the occurrence of asymmetry. Many treatment modalities and possible surgical perspectives are known, yet, so far, no adequate detailed guidelines are known. This detailed review of this type of mandibular asymmetry will focus on diagnostics and treatment plans and outcomes. The following paper underlines the authors' own clinical experiences in MA and UCH treatment, which are compared with the literature review. The authors intend to investigate what has changed in the treatment and diagnostics of one-sided mandibular condyle and bone overgrowth. [ABSTRACT FROM AUTHOR]

This study aims to introduce and evaluate a novel technique to treat unilateral condylar hyperplasia (UCH) by electrocauterization of the mandibular condyle via an intraoral approach. Patients suffering from unilateral condylar hyperplasia (UCH) were included in this study. All patients underwent electrocauterization of the affected condyle. An intraoral incision on the anterior border of the mandibular ramus was made to expose the external surface of the ramus and access the anterior border of the condylar head. A hole was then drilled into the condyle and cauterization was performed; six patients also received orthognathic surgery during the procedure. Patients underwent careful clinical assessment and radiological evaluation including panoramic view, lateral and posteroanterior cephalometry, cone-beam computed tomography (CBCT) and scintigraphy to assess condylar growth for a period of 12–24 months. Ten patients (5 male and 5 female) with active UCH type 1B or 2A were included in this study with a mean age of 20.7 years (range, 18–21.7 years). At the 12-month postoperative assessment, clinical evaluation showed stable dental occlusion with no midline shift; scintigraphy showed persistently reduced cellular activity, and computed tomography scans revealed no degeneration in either of the condyles with complete healing of the drilled holes. Within the limitations of this study it seems that the proposed treatment approach might be an alternative to previously established protocols. [ABSTRACT FROM AUTHOR]

In our clinic, the current preferred primary treatment regime for unilateral condylar hyperactivity is a proportional condylectomy in order to prevent secondary orthognathic surgery. Until recently, to determine the indicated size of reduction during surgery, we used a 'panorex-free-hand' method to measure the difference between left and right ramus heights. The problem encountered with this method was that our TMJ surgeons measured differences in the amount to resect during surgery. Other 2D and 3D method comparisons were unavailable. The aim of this study was to determine the most reproducible ramus height measuring method. Differences in left/right ramus height were measured in 32 patients using three methods: one 3D and two 2D. The inter- and intra-observer reliabilities were determined for each method. All methods showed excellent intra-observer reliability (ICC > 0.9). Excellent inter-observer reliability was also attained with the panorex-bisection method (ICC > 0.9), while the CBCT and panorex-free-hand gave good results (0.75 < ICC < 0.9). However, the lower boundary of the 95% CI (0.06–0.97) of the inter-observer reliability regarding the panorex-free-hand was poor. Therefore, we discourage the use of the panorex-free-hand method to measure ramus height differences in clinical practice. The panorex-bisection method was the most reproducible method. When planning a proportional condylectomy, we advise applying the panorex-bisection method or using an optimized 3D-measuring method. [ABSTRACT FROM AUTHOR]

Objectives: Unilateral condylar hyperplasia (UCH), marked by progressive condylar growth, occurs between ages 11-30 with unclear etiology. This retrospective study aims to clarify the clinical, radiographic, and demographic features of UCH to improve its diagnosis and treatment., Material and Methods: Data for all patients included in this study were retrieved from the archive. Inclusion criteria were the diagnosis of UCH supported by a positive bone scan above 10% of condylar uptake in SPECT/CT, the patient's history of progressive facial asymmetry, symptoms confirmed by the orthodontist during follow-up, and clinical and radiological evaluation. Demographic characteristics, along with volumetric and linear measurements, were statistically evaluated., Results: Forty-one patients were included in this study with 70.73% female predominance. Patients were classified as transverse and vertical type condylar hyperplasia (CH) according to their prominent asymmetry characteristics. Eighteen patients were classified as vertical type CH and 23 patients were classified as transverse type CH. Twenty had left-side condylar overgrowth, and 21 had right-side overgrowth. Condylar volume difference was significantly higher in vertical type CH patients compared to transverse type CH (p = 0.004). No correlation was found between growth rate (bone scan uptake ratio) and condylar volume difference in patients with vertical type and transverse type CH patients (p = 0.205)., Conclusion: Particularly in cases that exhibit a pronounced vertical growth tendency, volumetric and linear measurements can guide the timing and treatment planning process., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

This article outlines a conceptual approach to the reconstruction of jaw deformities associated with abnormalities in the mandibular condyle. The authors describe a hierarchy of reconstruction, emphasizing use of the least invasive and progressing to the most complex and invasive techniques, depending on the nature and severity of the underlying deformity, prior operations, patient age, and stage of growth. Consider joint preservation orthognathic surgical correction, followed by biological techniques for replacement of the condyle, and avoid replacing a functional temporomandibular joint based only on radiographic remodeling and concerns about potential future flare-ups of disease based on anecdotal data. [ABSTRACT FROM AUTHOR]

The following paper focuses on the topic of mandibular unilateral condyle hyperplasia (UCH). This form of mandibular asymmetry (MA) is one of the less common but still known pathologies that requires detailed surgical and orthodontic planning and treatment. Since this pathology is mostly related to a high number of individual dental, bone, and overgrowth factors, until now the treatment methods were individually driven. It seems that the scope of surgical intervention is greatly dependent on the degree of bone overgrowth and the occurrence of asymmetry. Many treatment modalities and possible surgical perspectives are known, yet, so far, no adequate detailed guidelines are known. This detailed review of this type of mandibular asymmetry will focus on diagnostics and treatment plans and outcomes. The following paper underlines the authors’ own clinical experiences in MA and UCH treatment, which are compared with the literature review. The authors intend to investigate what has changed in the treatment and diagnostics of one-sided mandibular condyle and bone overgrowth.

Abstract Background Unilateral condylar hyperplasia (UCH) of the mandible, or Hypercondylia, is a pathological condition that determines an abnormal growth of the affected condyle. Bone SPECT with Tc99m-diphosphonates is a successful tool in the diagnosis of UCH. EANM guidelines also suggest the use of 18F–NaF PET/CT, though it leads to a higher radiation exposure. Aim As UCH patients are young, we aimed to develop a low dose 18F–Fluoride PET/CT protocol and compare it to a standard injected activity scan, to assess if the image quality remains unchanged. Materials and methods We prospectively enrolled 20 patients (7 males, 13 females, mean age 23.2) with UCH, who underwent 18F–NaF PET/CT to assess the hypercondylia. We administered a low activity of 18F–NaF (2.9 MBq/kg) in 15 patients and a standard activity (5.3 MBq/kg) in 5 patients. Activity range was chosen according to 2015 EANM guidelines. To determine if the scans with low radiotracer activity were “diagnostic” such as those with standard activity, two expert nuclear medicine physicians, unaware of the administered activity, independently reviewed the scans and expressed a final qualitative judgment in terms of “diagnostic”/“non-diagnostic” scan. Furthermore, we compared the effective dose of a low injected activity PET/CT to the standard one and to a Bone SPECT performed with standard injected activity of Tc99m-diphosphonates. Results Reviewers classified 19 of 20 scans as “diagnostic”. Only one of them was classified as “non diagnostic” due to condylar arthrosis that disturbed the correct evaluation of condylar radiotracer uptake. The effective dose of a 18F–Fluoride PET/CT, in patient of 70 kg, is about 3.5 mSv in scans performed with 2.9 MBq/kg [0.017 mSv/MBq × 2.9 MBq/kg × 70 kg] and about 6.3 mSv in ones performed with 5.3 MBq/kg [0.017 mSv/MBq × 5.3 MBq/kg × 70 kg]. The effective dose of 99mTc-MDP bone SPECT is about 3.2 mSv [0.0043 mSv/MBq × 740 MBq of 99mTc-MDP]. Discussion 18F–NaF PET/CT performed with a low radiotracer activity allows a good assessment of UCH similar to that performed with an ordinary activity. The effective radiation dose of a low-injected activity PET/CT is significantly lower than an ordinary-injected activity and is not significantly higher than the most used Bone SPECT. Moreover PET/CT is performed in 1.5 h while Bone SPECT requires at least 3.5 h. Conclusions The 18F–Fluoride PET/CT procedure could be performed with 2.9 MBq/Kg (minimum 185 MBq, recommended at least 200 MBq) of 18F–NaF to minimize the effective radiation dose received, maintaining the quality of the scan. Further studies including a larger number of patients and clinical follow-up are needed to confirm our preliminary findings.

Hemifacial hyperplasia (HFH) is characterized by an increase in volume of all affected tissues of half of the face. It is present at birth, subsequently grows proportionally, and stops growing before adulthood. Unilateral condylar hyperplasia (UCH) consists of progressive asymmetric growth of the mandible and develops typically in early adulthood. Both disorders have an unknown aetiology. The overgrowth limited to one body part suggests somatic mosaicism, as this has been found in other similar localized overgrowth disorders. Often this includes a variant in a gene in the (PIK3CA)/PI3K/(PTEN)/AKT1/mTOR pathway. Here we report the case of an HFH patient with asymmetry present at birth, in whom a progressive growth pattern similar to UCH subsequently occurred, causing marked mandibular asymmetry. A condylectomy was successfully performed to stop the progressive growth. Somatic mosaicism for a mutation in PIK3CA was detected in the condylar tissue. This finding might indicate that both HFH and UCH can be caused by variants in genes in the (PIK3CA)/PI3K/(PTEN)/AKT1/mTOR pathway, similar to other disorders that result in asymmetrical bodily overgrowth. [ABSTRACT FROM AUTHOR]

Unilateral condylar hyperplasia (UCH) causes progressive asymmetry of the mandible. The aetiology of this growth disorder is unknown. A two-centre prospective study was established, and 10 consecutive adult UCH patients scheduled for high condylectomy were included. The resected condylar tissue was divided into two parts, one for regular histopathology and one for DNA extraction. A panel of eight selected overgrowth genes (AKT1 , AKT3 , MTOR , PIK3CA , PIK3R2 , PTEN , TSC1 , TSC2) were sequenced using next-generation sequencing, with coverage of a minimum 500 times in order to be able to detect low-grade mosaicisms. Subsequently, untargeted whole exome sequencing (WES) was performed to detect variants in other genes present in three or more patients. No mutation was detected in any of the overgrowth genes, and untargeted exome sequencing failed to detect any definitively causative variant in any other gene. Ten genes had a rare variant in three or more patients, but these cannot be designated as causative without additional functional studies. The hypothesis that the cause in at least some patients with UCH is a somatic mutation in a gene that controls cell growth could not be confirmed in this study. [ABSTRACT FROM AUTHOR]

A 29-year-old female patient with unilateral condylar hyperplasia (UCH) of the left side presented with facial asymmetry, maxillary transverse occlusal plane (MXTOP) cant, posterior open bite, and Class III relationship. Treatment consisted of proportional condylectomy of the left condyle for management of UCH, and fixed orthodontic treatment with intrusion of the left maxillary molars to correct the MXTOP cant and remaining chin point deviation (CPD). Proportional condylectomy with a 14-mm resection of the left condylar head improved the CPD from 11.5 mm to 7.8 mm and resolved the posterior open bite on the left side. However, it produced a Class II relationship on the right and left sides, posterior open bite on the right side, and anterior open bite. Fixed orthodontic treatment with 1.8-mm intrusion of the left maxillary molars using miniscrews corrected the MXTOP cant from 3.5 mm to 1.7 mm, reduced the remaining CPD from 7.8 mm to 3.7 mm, produced counterclockwise rotation of the mandible, and resolved the posterior open bite on the right side and the anterior open bite. After 16 months of total treatment, normal overbite/overjet and Class I relationship were obtained. Treatment results were well maintained after 5 years of retention. For the correction of UCH, it is important to determine the amount of condylar head resection and accurately simulate the correction of CPD and MXTOP cant through intrusion of the maxillary molars. [ABSTRACT FROM AUTHOR]

Unilateral condylar hyperplasia (UCH) of the mandible is a disorder affecting the condyle size, resulting in facial asymmetry. This study was a retrospective review of 27 patients with UCH who underwent condylectomy between 2000 and 2017 at Yonsei University Dental Hospital. Patient demographic characteristics were summarized. UCH was divided into three subtypes: hemimandibular elongation (HE, n = 15), hemimandibular hyperplasia (HH, n = 4), and osteochondroma (OC, n = 8). Of the 27 patients, only one with the HE type and five (18.5%) with the OC type complained of joint pain. Bone scans of all patients showed higher uptake on the UCH side. Lip and maxillary canting was prominent in the HH and HE types. Five patients (18.5%) underwent condylectomy alone, 13 (48.1%) underwent condylectomy with orthodontic treatment, and nine (33.3%) underwent adjunctive jaw surgery with orthodontic treatment. The treatment modalities varied according to the subtype. In all OC type patients, removal of the hyperplastic condyle treated the facial asymmetry. Additional post-surgical orthodontic treatment was necessary in only three cases (37.5%). All HH type patients required mandibuloplasty. All patients showed a stable occlusal outcome without relapse and an improvement in subjective symptoms, despite a decrease in mouth opening of 2.2 mm. These findings might be useful in treatment planning for UCH patients. [ABSTRACT FROM AUTHOR]

Unilateral condylar hyperplasia (UCH) is a pathological condition characterized by unrestrained growth of condyle unilaterally and is of idiopathic in nature. It is often diagnosed clinically but more frequently if not always is augmented by planar and single photon emission computed tomography bone scans to confirm the finding. Hence, bone scintigraphy using technetium-99 m methylene diphosphonate is the diagnostic tool to identify these active growth centers. Detection and excision of active growth center are the line of management for condylar hyperplasia. This article highlights the importance of using these radioactive scans to diagnose as well as to monitor the prognosis of UCH in two such cases.

Abstract Purpose Unilateral Condylar Hyperplasia (UCH) is an acquired deformity of the mandible, which can highly influence the symmetry of the face due to its progressive nature. It is caused by growth resembling pathology in one of the mandibular condyles. Definition as well as classification is subject to discussion. The aim of this study is to evaluate a large cohort of alleged UCH patients, and to describe the clinical characteristics, demographic features, classification and follow up. Secondly an algorithm is presented, in order to achieve uniformity in diagnosis and treatment. Patients and methods From 1994 to 2014 a database of consecutive patients from 3 maxillofacial departments (Academic Medical Center, Amsterdam; VU Medical Center, Amsterdam and Spaarne Gasthuis, Haarlem) with suspected UCH was set up. Patients were referred by orthodontists, dentists, general practitioners or maxillofacial surgeons. Demographic features, bonescan outcomes, laterality, classification and follow-up were noted. Secondarily, all patients were retrospectively diagnosed by one surgeon (JWN), using available documentation. Missing data and follow-up were additionally retrieved from orthodontic offices. Results 394 asymmetric patients were evaluated. In 309 (78%) patients, the diagnosis UCH was justified and SPECT data were available. The mean age at presentation was 20.3 years (SD ± 7.7, range 9.0–54.5 years). In 48% of the patients, the bonescan was positive. 80% of these patients received surgical treatment, of which 62% were treated with a condylectomy only, 33% were treated with condylectomy plus additive corrective surgery, and 5% underwent corrective surgery only. Of the patient group without positive bonescan 42% of the patients received surgical treatment: 34% condylectomy only, 15% condylectomy plus additive corrective surgery, and 51% corrective surgery only. In total (N = 309) 96 (31%) patients underwent condylectomy as only surgical treatment and 124 (40%) patients received no surgical treatment at all. Treatment could be finalized with orthodontic treatment without further surgery in 64% and 41% respectively. 96 patients were subject to comparison of the classification as noted by the clinician and the author (JWN). In only 72% of the cases, the secondary screening was in agreement with the initial classification. Conclusion Based on this study not all (active) UCH patients require corrective (orthognathic) surgery. A (transoral) partial condylectomy for active patients is recommended, with a postoperative remodeling period of 6 months with or without orthodontic treatment. Second stage correcting surgery may be necessary upon evaluation, using general orthognathic diagnostic and planning procedures. It appears difficult to classify patients reliably using the available clinical and radiological documentation. Objectivity and quantification in the diagnostic process is necessary: uniformity in documentation and parameters. The attached documentation form and UCH treatment algorithm is recommended. [ABSTRACT FROM AUTHOR]

Facial asymmetry can be caused by unilateral condylar hyperplasia. In such cases, it may be difficult to achieve symmetry since there is dentoalveolar compensation on the affected side, and the occlusal cant does not correspond to the frontal mandibular deviation. In the case presented, surgical orthodontic treatment and orthognathic surgery planning was accomplished for a patient with facial asymmetry due to condylar hyperplasia. The surgical plan was devised with particular attention to the severe dentoalveolar compensation. In this case, prior to the two-jaw surgery, the occlusal cant and frontal mandibular plane inclination was corrected through impaction of the left molar region by segmental osteotomy. Facial asymmetry and severe dentoalveolar compensation were successfully corrected after a unilateral segmental osteotomy and two-jaw surgery, resulting in a stable occlusal relationship and facial symmetry as well as good jaw function. Collaboration between the orthodontists and maxillofacial surgeons was essential for the successful treatment of the patient. [ABSTRACT FROM AUTHOR]

Introduction Unilateral condylar hyperplasia (UCH) is characterized by an excessive growth of a mandibular condyle, resulting in facial, and occlusal deformities. Scintigraphic hyperactivity usually triggers the need of condylectomy. Delaire has presented a protocol for the treatment of active or non-active UCH using systematically a proportional condylectomy, which could solve both aetiology and adaptive deformities. The aim of this study was to evaluate this protocol by clinical and radiographical analysis. Materials and methods Seventy-three patients with UCH were included in this retrospective study, and divided by clinical and cephalometric analysis in vertical, or transversal forms of UCH according to Delaire's classification. All patients were treated with ‘proportional condylectomy’, any indicated orthognathic procedures, along with maxilla-mandibular elastic therapy, and rehabilitation. Architectural, aesthetical, occlusal, and functional features were evaluated using clinical, cephalometric, and photographic measurements both preoperatively, and at the end of the follow-up. Results A female predominance was observed (65.8%). Vertical forms were more represented than transversal forms (61.6% versus 38.4%). There was a significant improvement of the occlusal plane, the posterior vertical excess, the chin deviation and the soft-tissue features (p < 0.0001), regardless of the preoperative scintigraphic activity status (p < 0.0001). The occlusion, and temporo-mandibular joint (TMJ) functions was considered as normal in respectively 72.7%, and 93% of the patients. Conclusion The results of this study have demonstrated that a protocol using a ‘proportional condylectomy’, any indicated orthognathic techniques, maxilla-mandibular elastic therapy, and rehabilitation, is a reliable option for treating UCH, regardless the activity status of the pathology. [ABSTRACT FROM AUTHOR]

This study aimed to describe the condylar layer and cartilage island in subjects with unilateral condylar hyperplasia (UCH). Five individuals (15–18 years old) with a diagnosis of UCH, treated in a university hospital in Temuco, Chile, were included. The analysis examined the presence, extension, and thickness of the layers on the condylar surface, the number, depth, and area of the cartilage islands, and the argyrophilic proteins of the nucleolar organizer region (AgNOR) score. Statistical significance was set at P < 0.05. The fibrocartilaginous layer was thickest (0.13 ± 0.05 mm) and the joint layer was thinnest (0.07 ± 0.01 mm) ( P < 0.05). With respect to the number, depth, and area of the islands, case 1 presented the highest values, followed by case 2; the cartilage island was related to the fibrocartilaginous layer ( P < 0.05). All cases had AgNOR proteins in the proliferative and fibrocartilaginous layers, as well as the islands with the greatest presence of chondrocytes ( P = 0.245). A relationship was observed between the histopathological alterations in the different layers on the condylar surface and the thickness of the fibrocartilaginous layer, as well as the thickness of the latter and the number, depth, and area of the cartilage islands in the trabecular bone. [ABSTRACT FROM AUTHOR]

Purpose Three-dimensional quantification of asymmetry in UCH has not been reported yet, but would be useful for diagnosing and evaluating the degree of deformity in this disease. It enables profound decision-making and timing of surgery. Unilateral condylar hyperplasia (UCH) can subjectively be classified in hemimandibular elongation (HE), hemimandibular hyperplasia (HH) and a combination of these two (hybrid form). The main purpose of this study was to quantify mandibular asymmetry in UCH patients with a reliable and reproducible method. Secondly, it was evaluated whether the existing classification can be confirmed. Materials and methods 37 UCH-patients with progressive mandibular asymmetry, supported by a positive bone scan and/or such clinical progression that condylectomy was performed, were included in this retrospective study. A group of healthy subjects, matched for age and gender, was used as the control group. Cone-beam computed tomography (CBCT) scans were imported in Maxilim ® software. Each mandibular half was divided into three skeletal segments (condyle, ramus, and body). Linear and volumetric measurements were calculated for these skeletal units on the affected and unaffected side, for both patients and controls. Results Significant differences between affected and unaffected sides in the patient group were found in condylar, ramus, and body segments for linear (p < 0.01) as well as for volumetric quantitative measurements (p < 0.0040). A mean linear difference between affected and unaffected sides in the condylar region of the UCH patient group was found of 3.6 mm (sd 2.9) versus 0.2 mm (sd 1.5) in controls. For volumetric measurements there was a mean difference between the left and right condyle of 718 mm 3 (sd 638) in the patient group versus 8 mm 3 (sd 225) difference in the control group. The condyle was the most affected segment. Differences between sides were significantly larger in the patient group than in the control group (p < 0.001). It was not possible to objectify differences between HE and HH. Conclusion CBCT is a useful and accurate modality for quantification and evaluation of mandibular asymmetry in UCH. It enables objective monitoring. The existing classification in HE and HH could not be confirmed. [ABSTRACT FROM AUTHOR]

Mandibular condylar hyperplasia (MCH) is a rare, idiopathic disorder, which can cause both functional and aesthetic problems. MCH has often been described in the literature, but a comprehensive analysis of the current literature on MCH has not been undertaken. This study presents a systematic review analyzing the efficacy of high condylectomy in patients with MCH, with an emphasis on its role in the management of unilateral condylar hyperplasia. A systematic search of the current literature on high condylectomy was performed to find studies with sample sizes of more than five patients using a set of inclusion/exclusion criteria. The search terms revealed 664 studies, of which only 11 articles with a total of 289 patients were eligible for inclusion. Due to differences in the presentation of data, a meta-analysis was not conducted. High condylectomy appears to be a relevant surgical method to correct unilateral condylar hyperplasia. The current literature indicates large variations in terms of aetiology, use of diagnostic tools, and preferred time of intervention. Thus, further systematic studies are needed to determine which procedures offer the best aesthetic and functional results. [ABSTRACT FROM AUTHOR]

Patients with suspected unilateral condylar hyperplasia are often screened radiologically with a panoramic radiograph, but this is not sufficient for routine diagnosis and follow up. We have therefore made a quantitative analysis and evaluation of panoramic radiographs in a large group of patients with the condition. During the period 1994–2011, 132 patients with 113 panoramic radiographs were analysed using a validated method. There was good reproducibility between observers, but the condylar neck and head were the regions reported with least reliability. Although in most patients asymmetry of the condylar head, neck, and ramus was confirmed, the kappa coefficient as an indicator of agreement between two observers was poor (−0.040 to 0.504). Hardly any difference between sides was measured at the gonion angle, and the body appeared to be higher on the affected side in 80% of patients. Panoramic radiographs might be suitable for screening, but are not suitable for the quantitative evaluation, classification, and follow up of patients with unilateral condylar hyperplasia. [ABSTRACT FROM AUTHOR]

Background: Surgery First Approach (SFA) and Surgery Early (SE) are considered promising alternatives, compared to the conventional three-stages orthodontic-surgical approach, for treatment of dento-maxillofacial deformities. However, many features need further study, like the role of the orthodontist. Aim of the study was to analyse the clinical characteristics of patients who underwent SFA and SE, and if differences in duration of orthodontics could be influenced by clinical features., Methods: A retrospective research was performed on patients who met the inclusion criteria for SFA (31) and SE (12), of the total of patients affected by dento-facial deformities in our Unit (191) in the period 2012-2017. After collection of clinical data, duration of orthodontics, age, pre-treatment PAR Index, ANB angle, amount of the curve of Spee were compared. A regression analysis evaluated if these clinical parameters, together with type of bracket and type of intervention, could influence the duration of post-surgical orthodontics., Results: All patients who performed the SFA/SE were affected by class III, II and active Unilateral Condylar Hyperplasia (22% of total population). Pre-treatment mean differences of age (p = 0.0518), PAR Index (p = 0.0916), curve of Spee (p = 0.1006) between groups were not statistically significant. A statically significant difference was found for the overall duration of therapy, for the significant shorter duration of pre-surgical orthodontics, while the difference of post-surgical orthodontics duration was not significant (p = 0.4753). Type of bracket (rho=-0.19039, p = 0.266) and intervention performed (rho=-0.11522, p = 0.5034) were not correlated with duration of post-surgical orthodontics, as well as pre-treatment PAR Index, ANB angle and depth of the curve of Spee., Conclusions: Surgery First/Early Approach is a therapeutic choice that could be performed only in patients affected by specific malocclusions and who exactly meet indications. Protocol and post-surgical occlusal stability are factors that should influence the duration of therapy more than clinical characteristics., Competing Interests: Declaration of Competing Interest Declarations of competing interest: none for all the Authors., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

A 25-year-old woman presented with left condylar hyperplasia, canting-type facial asymmetry, mandibular prognathism, and arch width discrepancy. Bone scintigraphy confirmed the inactive status of the condyle, and the temporomandibular joint functioned within the normal range; thus, orthognathic surgery without condylectomy was performed. To correct facial asymmetry successfully through orthognathic surgery, sufficient dentoalveolar decompensation must be achieved in the presurgical orthodontic phase. In cases of canting-type facial asymmetry, teeth on the nondeviated side are extruded as dentoalveolar compensation. Therefore, vertical decompensation is required for intrusion of the extruded teeth. A miniscrew and resin build-ups were used for the intrusion of teeth, and posterior segmental osteotomy was simultaneously performed with orthognathic surgery for further intrusion. The canting-type facial asymmetry was notably corrected through successful vertical decompensation and close cooperation between orthodontists and maxillofacial surgeons. After 2 years of retention, the treatment results remained stable., (© 0000 by The EH Angle Education and Research Foundation, Inc.)

Abstract: Bone scan analyses and clinical assessment are used to diagnose unilateral condylar hyperactivity (UCH). This review compares the diagnostic accuracy of planar and SPECT bone scans. Studies diagnosing patients with possible UCH using bone scans, published between 1968 and 2008, were included in this review. Of 15 articles that met the inclusion criteria, 7 presented results in sufficient detail to calculate index test characteristics. Three control studies show that the difference in uptake values of the left and right condylar regions in the normal population does not exceed 10%. The pooled sensitivity of the planar bone scan (n =130) was 0.71 (95% confidence interval: 0.57–0.82), which was significantly lower (p =0.04) than that of the bone SPECT technique (n =88), which was 0.90 (0.79–0.97). The pooled specificity of the SPECT scan was 0.95 (0.82–0.99), which did not significantly differ (p =0.58) from that of the planar scan (0.92 (0.83–0.97)). Future studies should include a diagnostic analysis of the data, including two-by-two contingency tables, so the accuracy of the diagnostic test may be evaluated. Bone scans are best performed using SPECT, conducting a quantitative analysis by calculating the percentile differences between the left and right condylar regions. [Copyright &y& Elsevier]

Abstract: This study aimed to compare different analytical methods and identify the optimal analysis method to distinguish patients with unilateral condylar hyperactivity (UCH) from those with inactive condyles. Single-photon emission computed tomography (SPECT) scans of patients with progressive and nonprogressive mandibular asymmetry (each group, n =26), were analyzed using the region of interest technique. Sensitivity, specificity and receiver operating characteristic (ROC) curves were calculated for the different analytic methods. The ROC curve illustrates that UCH can be diagnosed significantly better by determining the percentile bone activity in both condyles. The area under the curve (AUC) of the percentile comparison between the affected and contralateral condyles was 0.93±0.04, that for the condyle/clivus ratio was 0.75±0.07 and for the condyle/cervical spine (CS) ratio 0.57±0.08. Sensitivity for the condyle/clivus ratio was 65% and specificity 61%. Sensitivity for the condyle/CS ratio was 85% and specificity 31%. For the percentile difference of the condyles, sensitivity and specificity were 88%. For UCH patients, direct comparison of bone activity between the affected and contralateral condyle in SPECT scans is the analysis method of choice. Comparison of condylar bone activity to reference bone activity does not have additional value in the diagnosis of UCH. [Copyright &y& Elsevier]

Objectives: The mounting of the plaster casts on articulator procedure is routinely performed in orthognathic surgery to assess canting of the maxillary occlusal plane, but the currently used protocols and reference plane could be source of errors which affect reliability. Nowadays the assessment of canting of the maxillary occlusal plane could be also performed with an entirely digital protocol. Aim of the study was to propose a method to evaluate canting in patients affected by Unilateral Condylar Hyperplasia, comparing the measurements performed on digital models matched on CBCT with those made on traditional articulator., Materials and Methods: A retrospective cross-sectional study was designed on 20 patients affected by vertical Unilateral Condylar Hyperplasia treated in the Units of Orthodontics and Maxillo-Facial Surgery. The canting of the maxillary occlusal plane was measured on plaster casts mounted on the conventional articulator and the measures were compared with those made on digital models matched on CBCT, according the protocol developed in our Unit. Molar, canine and basal difference were measured. To compare the two protocols and to test the agreement, we performed descriptive statistics, comparison between means and Bland Altman analysis. P value was set at 0.05., Results: Statistic comparison demonstrated agreement between measurements performed with the digital protocol and conventional physical method., Conclusion: Measurements of canting with digital protocol are comparable to the physical standard method. A total digital protocol allows faster availability and storage of patient's data and better communication between orthodontist and maxillo-facial surgeon, especially in patients affected by three-dimensional malocclusions., Competing Interests: Conflict of interest None., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Unilateral condylar hyperplasia (UCH) of the mandible, or Hypercondylia, is a pathological condition that determines an abnormal growth of the affected condyle. Bone SPECT with Tc99m-diphosphonates is a successful tool in the diagnosis of UCH. EANM guidelines also suggest the use of 18F–NaF PET/CT, though it leads to a higher radiation exposure. Aim: As UCH patients are young, we aimed to develop a low dose 18F–Fluoride PET/CT protocol and compare it to a standard injected activity scan, to assess if the image quality remains unchanged. Materials and methods: We prospectively enrolled 20 patients (7 males, 13 females, mean age 23.2) with UCH, who underwent 18F–NaF PET/CT to assess the hypercondylia. We administered a low activity of 18F–NaF (2.9 MBq/kg) in 15 patients and a standard activity (5.3 MBq/kg) in 5 patients. Activity range was chosen according to 2015 EANM guidelines. To determine if the scans with low radiotracer activity were "diagnostic" such as those with standard activity, two expert nuclear medicine physicians, unaware of the administered activity, independently reviewed the scans and expressed a final qualitative judgment in terms of "diagnostic"/"non-diagnostic" scan. Furthermore, we compared the effective dose of a low injected activity PET/CT to the standard one and to a Bone SPECT performed with standard injected activity of Tc99m-diphosphonates. Results: Reviewers classified 19 of 20 scans as "diagnostic". Only one of them was classified as "non diagnostic" due to condylar arthrosis that disturbed the correct evaluation of condylar radiotracer uptake. The effective dose of a 18F–Fluoride PET/CT, in patient of 70 kg, is about 3.5 mSv in scans performed with 2.9 MBq/kg [0.017 mSv/MBq × 2.9 MBq/kg × 70 kg] and about 6.3 mSv in ones performed with 5.3 MBq/kg [0.017 mSv/MBq × 5.3 MBq/kg × 70 kg]. The effective dose of 99mTc-MDP bone SPECT is about 3.2 mSv [0.0043 mSv/MBq × 740 MBq of 99mTc-MDP]. Discussion: 18F–NaF PET/CT performed with a low radiotracer activity allows a good assessment of UCH similar to that performed with an ordinary activity. The effective radiation dose of a low-injected activity PET/CT is significantly lower than an ordinary-injected activity and is not significantly higher than the most used Bone SPECT. Moreover PET/CT is performed in 1.5 h while Bone SPECT requires at least 3.5 h. Conclusions: The 18F–Fluoride PET/CT procedure could be performed with 2.9 MBq/Kg (minimum 185 MBq, recommended at least 200 MBq) of 18F–NaF to minimize the effective radiation dose received, maintaining the quality of the scan. Further studies including a larger number of patients and clinical follow-up are needed to confirm our preliminary findings. [ABSTRACT FROM AUTHOR]