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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

Purpose Our current understanding of unilateral condylar hyperplasia (UCH) was put forth by Obwegeser. He hypothesized that UCH is 2 separate conditions: hemimandibular hyperplasia and hemimandibular elongation. This hypothesis was based on the following 3 assumptions: 1) the direction of overgrowth, in UCH, is bimodal—vertical or horizontal, with rare cases growing obliquely; 2) UCH can expand a hemimandible with and without significant condylar enlargement; and 3) there is an association between the condylar expansion and the direction of overgrowth—minimal expansion resulting in horizontal growth and significant enlargement causing vertical displacement. The purpose of this study was to test these assumptions. Patients and Methods We analyzed the computed tomography scans of 40 patients with UCH. First, we used a Silverman Cluster analysis to determine how the direction of overgrowth is distributed in the UCH population. Next, we evaluated the relationship between hemimandibular overgrowth and condylar enlargement to confirm that overgrowth can occur independently of condylar expansion. Finally, we assessed the relationship between the degree of condylar enlargement and the direction of overgrowth to ascertain if condylar expansion determines the direction of growth. Results Our first investigation demonstrates that the general impression that UCH is bimodal is wrong. The growth vectors in UCH are unimodally distributed, with the vast majority of cases growing diagonally. Our second investigation confirms the observation that UCH can expand a hemimandible with and without significant condylar enlargement. Our last investigation determined that in UCH, there is no association between the degree of condylar expansion and the direction of the overgrowth. Conclusions The results of this study disprove the idea that UCH is 2 different conditions: hemimandibular hyperplasia and hemimandibular elongation. It also provides new insights about the pathophysiology of UCH.

Condylar hyperplasia (CH) is an overgrowth disorder of the temporomandibular joint bones caused by growth center overactivity of the mandibular condyle. Although the disorder is mostly idiopathic, several etiologies have been proposed. CH presents as progressive facial asymmetry with functional abnormalities. A combination of clinical, histopathological, and radiological findings is crucial to determine the diagnosis. Several diagnostic algorithms have been described in the literature. Management of CH is variable and depends on the growth of the bone. Here, we present the case of a 36-year-old female who presented with progressive facial asymmetry which was diagnosed as unilateral CH with active bony overgrowth.

RESUMEN La hiperplasia condilar es una malformación del desarrollo que causa un crecimiento anormal del cóndilo mandibular. Es un término genérico que describe condiciones que ocasionan un crecimiento excesivo y alargamiento del cóndilo mandibular, alterando la oclusión e indirectamente afectando el maxilar. El tratamiento habitual para esta patología consiste en una condilectomía mediante un abordaje extraoral. El objetivo de este trabajo es presentar el caso de una hiperplasia condilar unilateral activa, que fue tratada mediante condilectomía baja con abordaje intraoral y cirugía ortognática. El abordaje intraoral para una condilectomía ha sido poco documentado, sin embargo, ofrece numerosas ventajas y puede realizarse de forma segura.

Condylar hyperplasia is a temporomandibular joint progressive disease characterized by an excessive growth of the mandibular condyle. Condylar overgrowth represents one of the most common causes of facial asymmetry in early adulthood. To date, there is not a clearly established origin of the disease: genetic, traumatic, infective, vascular, and functional factors are involved hypotheses. Clinically, condylar hyperplasia presentation is characterized by an asymmetry of the lower third of the face, deviation of the chin, inclination of the labial line and malocclusion. Several treatments have been proposed over the years in the treatment of mandibular condyle hyperplasia, but to date a gold standard has not been defined. Two are the main approaches: condylectomy and orthognathic surgery, isolated or in a combination. Many condylectomy technique differentiations have been developed: high, low, and proportional, are the most performed. In this technical note, the Slice Functional Condylectomy (SFC), a modification of the proportional condylectomy is presented.

INTRODUCTION: The objectives of this study were to evaluate postsurgical condylar remodeling using a radiographical interpretation, quantify condylar volumetric asymmetry, and assess soft tissue symmetry after simultaneous unilateral high condylectomy and bimaxillary osteotomies. METHODS: Sixteen patients diagnosed with unilateral condylar hyperplasia underwent unilateral high condylectomy and orthognathic surgery to correct skeletal and facial asymmetries. Cone-beam computed tomography scans were acquired before and 1-year after surgery. A radiographic consensus was evaluated for signs of reparative or degenerative changes. The condyles were mirrored and registered for assessment of volumetric and morphologic asymmetry. Soft tissue symmetry was evaluated by measurement of the distance of soft tissue pogonion from the skeletal midsagittal plane. RESULTS: Patients who undergo unilateral high condylectomy and orthognathic surgery present radiographic signs suggestive of degenerative changes, including sclerosis, osteophytes, flattening, and erosion in both the surgical and nonsurgical condyles (P ≤ 0.01). There was an average volumetric improvement of 531.9 ± 662.3 mm(3) 1-year postsurgery (P = 0.006). Soft tissue symmetry improved in all patients, with an average improvement of 65.8% (4.0 mm ± 2.6 mm, P ≤ 0.01). There was no correlation between the change in condylar volumetric asymmetry and the stability of the soft tissue correction. CONCLUSIONS: High condylectomy for the correction of a skeletal asymmetry in patients with condylar hyperplasia successfully reduces the volumetric asymmetry between the condyles. Postsurgical dysmorphic remodeling and degenerative changes were noted in both the surgical and nonsurgical condyles. Despite remarkable changes and remaining joint asymmetry, the soft tissue correction is stable 1-year postsurgery. (Am J Orthod Dentofacial Orthop 2021;B:B-B)

The purpose of this study is to evaluate whether additive manufactory technology through the use of 3D mandible and skull cast models can provide additional support to the virtual surgical planning for patients affected by unilateral condylar hyperplasia (UCH). This study describes 2 patients affected by active UCH. Cone beam computed tomography (CBCT) scans were converted in STL files and then sent to a 3D printer that provided 3D cast models of patient's mandible and skull. Surgical planning was conducted performing linear measurement both on 3D virtual images and on 3D cast models. Proportional condylectomy was then simulated with the virtual software and on the 3D cast models as well. After 18 months, new CBCT scans of the patients were acquired and new 3D cast models were printed. Measurements performed on the 3D cast models were close and reliable if compared to measurements obtained on 3D virtual images. None of the patients underwent further surgeries obtaining stable results in terms of symmetry. 3D printing technologies have a relevant support for a more accurate planning and surgical treatment in UCH. Sin financiación 1.046 JCR (2020) Q4, 188/212 Surgery 0.515 SJR (2020) Q2, 205/456 Surgery No data IDR 2019 UEM

Condylar hyperplasia (CH) is a rare idiopathic condition affecting the mandibular condyle where the growth of the condylar head and/or neck continues beyond the normal growth period. This disorder presents clinically as facial asymmetry and occlusal discrepancy. Here, we present two cases of CH managed at our centers during the period between 2012 and 2017 with a successful outcome. We highlight the clinical presentation, investigation, and surgical management and give a brief literature review.

The sagittal split ramus osteotomy is a key approach for treating dentofacial deformities. Although it delivers excellent results, the sagittal split ramus osteotomy is believed to induce stress to the temporomandibular joint. Potential stress inducers could be classified as intra- and postoperative factors resulting in an inflammatory response and molecular cascades, which initiate physiological remodeling. Occasionally, this process exceeds its capacity and causes pathological remodeling, through either degenerative joint disease or condylar resorption. Hard evidence on how orthognathic surgery causes inflammation and how this inflammation is linked to the spectrum of remodeling remains scarce. Current concepts on this matter are mainly based on clinical observations and molecular mechanisms are extrapolated from fundamental research in other body parts or joints. This perspective study provides an overview of current knowledge on molecular pathways and biomechanical effects in temporomandibular joint remodeling. It provides research directions that could lead to acquiring fundamental evidence of the relation of orthognathic surgery and inflammation and its role in remodeling. Performing osteotomies in animal models and identifying inflammatory mediators as well as their effect on the joint seem promising. Patients affected by pathological remodeling can also provide samples for histological as well as molecular analysis. Individual susceptibility analysis by linking certain suspect phenotypes to genetic variation could identify the cause and molecular pathway responsible for degenerative joint disease and condylar resorption, ultimately leading to clinically applicable treatment and prevention strategies. ispartof: FRONTIERS IN PHYSIOLOGY vol:10 ispartof: location:Switzerland status: published

Condylar hyperplasia (CH) of the mandible is a rare pathology that occurs at the head of the condyle and can lead to facial asymmetry affecting occlusion and possible association with pain and dysfunction. Unilateral condylar hyperplasia is an uncommon condition of unknown aetiology, proper diagnosis of which has to be established, as the patients may look for surgical help. A rare case of unilateral condylar hyperplasia of the mandible is reported here.

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.

Facial asymmetry related to unilateral condylar hyperplasia is one of the facial deformities diseases, usually treated with TMJ surgery. The aim of this review is to define if condylar reparation is possible after partial resection of the condylar head and establish the conditions. We realized a search in Pubmed Central, Science Citation Index, Elsevier Science Direct Complete, Highwire Press, Springer Standard Collection, to find the studies realized in condylar reparation after condylectomy in humans and animals. The results showed poor information for both, human and animal model research. The information shows that condylar reparation is possible after condyelectomy, demonstrating similar morphology with the normal non-operated condyles. Functional load, age and surgery presented relation with condylar reparation.

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.

Condylar hyperplasia is (CH) an uncommon malformation of the mandible involving change in size and morphology of the condylar neck and head. CH is an anomaly that usually occurs unilaterally and equally affects in both men and women. Hyperplasia of the condyle `differentiated into hemimandibular hyperplasia, hemimandibular elongation and CH. Here, we are presenting a case of 17-year-old male patient with unilateral CH and its review of the literature.

Purpose Single-photon emission computed tomography (SPECT) with technetium-99m diphosphates plays an important role in assessing unilateral condylar hyperplasia (UCH). The aim of this study was to evaluate whether quantification methods of SPECT plus CT (SPECT/CT) based on precise region-of-interest (ROI) drawings made under the guide of CT images were more accurate than conventional SPECT methods in the assessment of UCH growth. Materials and Methods This study is a nonblinded retrospective case series. Patients with UCH who had undergone SPECT/CT were enrolled. CT images were used to guide ROI drawings around the anatomic contour of the affected and contralateral condyles on SPECT/CT images versus fixed ROIs on conventional SPECT images. Mean and maximum values within the ROIs were recorded to compute percentile ratios. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves were calculated separately for SPECT-based methods (SPECTaver, SPECTmax) and SPECT/CT methods (SPECTCTaver, SPECTCTmax). The area under the ROC curve of each method was calculated and compared pairwise. Results Fifty-six patients (30 patients with progressive and 26 patients with nonprogressive mandibular asymmetry) were evaluated. SPECTmax had the highest sensitivity of 83.3%, followed by SPECTCTmax, SPECTaver, and SPECTCTaver. In contrast, SPECTaver, SPECTCTmax, and SPECTmax had similar specificities, PPVs, and NPVs. Nonetheless, SPECTCTaver had the lowest specificity, PPV, and NPV among all methods. ROC analysis also showed similar diagnostic performances among SPECTaver, SPECTmax, and SPECTCTmax (P > .05) and poorer diagnostic performance of SPECTCTaver compared with the other 3 methods (P Conclusions The method of using ROIs drawn around the contour of the condyle on SPECT/CT images does not show improved accuracy over conventional SPECT-fixed ROI methods in assessing UCH.

Objectives: To 1) explore the planar scintigraphic findings in asymmetry patients caused by unilateral condylar hyperplasia (UCH) or asymmetric mandibular hyperplasia (AMH); 2) develop a local agecondylar activity reference norm; and 3) check the accuracy of the new norm and compare with other analytical methods. Material and Method: Chinese patients with mandibular asymmetry and scintigraphic findings available were recruited. Clinical, radiographic records and scintigraphic condylar activity ratio (CAR) were studied. Regression analysis was performed to quantify the relationship between age and CAR to develop a new norm. The sensitivity of condylar activity assessment using a) traditional norm; b) new norm; and c) percentile difference was compared. In patients with serial data available, longitudinal analysis of the scintigraphic changes were checked. Result: 109 patients were eligible for the study. Significant difference in CAR was noted between UCH and AMH patients. Linear relationship was observed between age and CAR. A new norm of the age-CAR was established, which showed improved sensitivity in condylar activity prediction in UCH and AMH when compared with traditional norm. Relative to percentile difference, the sensitivity of new norm was lower in AMH but not in UCH patients. Serial analysis revealed gradual decline in CAR with minimal change in percentile difference. Conclusion and Clinical Relevance: There is difference in scintigraphic condylar activity between UCH and AMH patients. A norm of age-CAR relationship was established, which showed improved sensitivity in condylar activity prediction in UCH patients. Further study is required to confirm the role of scintigraphy in AMH.

Unilateral condylar hyperplasia is an uncommon condition with unknown etiology which causes overdevelopment of condyle leading to facial asymmetry, mandibular deviation, malocclusion, and articulation dysfunction. Two Indian families with unilateral condylar hyperplasia are presented where the similar abnormality was also detected in one of their parents. The condylar hyperplasia in these two families indicates that mandibular condylar hyperplasia could be genetic in origin.

Condylar hyperplasia (CH) is a rare, self-limiting process manifesting between the first and third decades of life. CH causes facial asymmetry and derangement of the occlusion. Management involves resection of the condylar head and orthognathic surgery. This paper describes the case of a 37-year-old woman with spontaneous onset of CH over a span of approximately 25 years. The condition was managed with resection of the condyle alone, which dramatically improved facial asymmetry and altered the occlusion within a few months of follow up. Orthodontic treatment was then carried out and the patient underwent orthognathic surgery after 3 years. The patient is currently satisfied with her appearance and function and there are no signs of recurrence. Hiperplasia condilar (HC) é um processo raro e auto-limitativo que ocorre entre a 1a e a 3a décadas de vida. Ela causa assimetria facial e alteração da oclusão. O tratamento envolve ressecção da cabeça do côndilo e cirurgia ortognática. Este artigo descreve o caso de uma mulher de 37 anos com início espontâneo de HC e duração de aproximadamente 25 anos. O tratamento foi feito com ressecção apenas do côndilo, o que melhorou consideravelmente a assimetria facial e a oclusão em poucos meses de acompanhamento. Seguiu-se o tratamento ortodôntico e a paciente foi submetida a cirurgia ortognática três anos depois. Atualmente a paciente está satisfeita com sua aparência e função, sem apresentar sinais de recorrência.

Purpose. To investigate the clinical value of99Tcm-MDP SPECT for the diagnosis of unilateral condylar hyperplasia (UCH).Methods. One hundred forty-nine patients who underwent mandibular99Tcm-MDP SPECT between January 2009 and December 2012 were studied, including 105 cases that were clinically suspected of UCH and 44 comparable cases without UCH as a control group.Results. Increased bone activity was observed in the affected condyles for all UCH patients. In the UCH group, the relative percentage uptake on the affected side was 59% (SD±4.3%), significantly higher than the 41% (SD±4.1%) uptake on the contralateral side (P1.66±0.63) than for the contralateral side (1.34±0.34,P<0.01. No significant difference was found in the control group between the left and right condyles. Values for the sensitivity (95%), specificity (61%), positive (84.4%) and negative (84.6%) predictive values, and accuracy (84.5%) for99Tcm-MDP SPECT in the diagnosis of UCH were calculated. However, for the hyperplastic condyle, no correlation was observed between the thickness of each cartilage layer and the relative uptake in the SPECT image.Conclusion.99Tcm-MDP SPECT is accurate for diagnosing UCH and can provide a reference for treatment options.

This study aimed to report six cases of unilateral condylar hyperplasia (CH), regarding their demographic and clinical characteristics and imaging and histopathological findings. Sex, age, affected side, history of the case, complementary examinations and treatment were recorded. Five cases (83.3%) were females and the mean age of the study population was 19.3 years (range: 14-28 years). The right condyle was affected in 4 cases (66.6%). Five (83.3%) patients were subjected to condylotomy, and high condylectomy was done in 1 (16.6%) case. The patients were followed up postoperatively for a mean period of 27.5 months. All patients received surgical and orthodontic treatment. In the present study, CH occurred more frequently in the first decades of life and it was more prevalent in females. The right condyle was more affected than the left one and condylotomy combined with orthodontics was the main treatment performed.

In unilateral condylar hyperplasia, for surgical intervention to be effective, the status of condylar bone growth has to be assessed correctly. Previously this assessment relied on serial clinical observations. This study aimed to evaluate the MDP-SPECT method of assessing condylar growth in unilateral condylar hyperplasia. Twenty-six MDP-SPECT of the mandible had been performed; 21 were diagnosed as condylar hyperplasia and five as non-mandibular disease. Three isotope parameters: isotope counts, pixel counts and counts per pixel were summed for each condyle per subject. The percentage difference in isotope uptake of the three parameters between the two condyles was calculated as the ratio of the combined counts of the two sides. These differences significantly correlated with each other (Pearson r = 0.78-0.98) and with the clinical status of bone growth (Spearman rho = 0.72-0.86). There was a significant difference for the count per pixel between the 'growing' condyle (transaxial, T: 15.05 � 7.14, coronal, C: 12.29 � 7.88), the 'no further growth' condyle (T: 5.22 � 4.08, C: 5.67 � 3.88) and the 'normal' condyle (T: 0.82 � 0.76, C: 1.34 � 0.66). This method was able to separate 'active growth' from 'growth cessation' of the condyle by a single MDP-SPECT of the mandible. However, further studies are needed to confirm this finding.

Contains fulltext : 117914.pdf (Publisher’s version ) (Open Access) PURPOSE: Objective quantifications of facial asymmetry in patients with Unilateral Condylar Hyperplasia (UCH) have not yet been described in literature. The aim of this study was to objectively quantify soft-tissue asymmetry in patients with UCH and to compare the findings with a control group using a new method. MATERIAL AND METHODS: Thirty 3D photographs of patients diagnosed with UCH were compared with 30 3D photographs of healthy controls. As UCH presents particularly in the mandible, a new method was used to isolate the lower part of the face to evaluate asymmetry of this part separately. The new method was validated by two observers using 3D photographs of five patients and five controls. RESULTS: A significant difference (0.79 mm) between patients and controls whole face asymmetry was found. Intra- and inter-observer differences of 0.011 mm (-0.034-0.011) and 0.017 mm (-0.007-0.042) respectively were found. These differences are irrelevant in clinical practice. CONCLUSION: After objective quantification, a significant difference was identified in soft-tissue asymmetry between patients with UCH and controls. The method used to isolate mandibular asymmetry was found to be valid and a suitable tool to evaluate facial asymmetry.

Two cases of active unilateral condylar hyperplasia which were treated with condylectomy alone are presented. The first case was an adult form and the other a juvenile form. Both were classified as active by using 99Tc bone scintigraphy. Clinical and radiographic features of both cases conformed to the hemimandibular hypertrophy type. Satisfactory facial symmetry and dental occlusion were achieved. Histopathological data confirmed the activity of the articular cartilage layers.

A case of a 57-years-old caucasian male with unilateral condylar hyperplasia and proven acromegaly is presented.