Search Results (11)

Background/Objectives: Condylectomy is a delicate and intricate procedure commonly employed in the management of temporomandibular joint (TMJ) disorders, osteochondromas, condylar hyperplasia, hemimandibular hyperplasia, and other pathologies affecting the condylar region. The advent of surgical cutting guides has introduced a new dimension to condylectomy procedures as they enable surgeons to plan and execute precise cuts with a heightened level of accuracy. In the literature already exists cases of cutting guide-based condylectomy, but they only depend on the mere mirroring procedure in virtual planning, which has accuracy limitations because it does not consider asymmetry of peri-condylar structures at the level of the ramus, body, and mandibular angle. Methods: CAD-CAM orthodontic preparation through the NEMOFAB Software was performed to correct the canting of the occlusal plane, following the “orthodontic first” technique. The same software was used for VSP of the surgical cutting guide to perform the condylectomy, basing not to the mere mirroring of the opposite side but considering the whole condylar-TMJ-glenoid fossa structure. Results: At 6 months follow-up, the patient showed good occlusion and an almost totally recovered lower third symmetry as median-upper and lower interincisive lines coincide with each other and with the chin median. A good occlusal and masticatory outcome was obtained. The joint structure was preserved with remodeling of the glenoid cavity caused by the presence of the joint disc, which was preserved during surgery. Conclusions: The goal of this study is to propose a method of therapeutic management of condylar hyperplasia that benefits from accurate pre-operative orthodontic treatment (orthodontics first) to maximize the results of proportional condylectomy, reducing post-operative orthodontic care as well as any need for any adjuvant orthognathic surgery. A new virtual surgical planning method is also proposed for creating a cutting guide that not only takes advantage of the mirroring technique to accurately calculate the amount of condyle to be cut but also considers the entire condyle–TMJ complex to perform a condylectomy that is more precise. Full article

Introduction: Facial asymmetry can be attributed to a multitude of underlying causes. Multiple reference points can be utilized for guidance in surgery planning. The scope of mandibular overgrowth and asymmetry should always be measured on CBCT radiographs (cone-beam computed tomography). The assessment of the mental foramen, and the supra and infraorbital foramina is crucial in surgical procedures. Their potential as reference points for predicting specific conditions has never been studied before. The authors explored if the mentioned foramina can be used for diagnostic purposes to distinguish the type of asymmetry or perhaps could improve any surgery planning in those skeletal asymmetry cases. Material and methods: Evaluation of 30 CBCT radiographs in the present preliminary study based on three study groups consisting of patients with normal skeletal features without any skeletal malocclusion (n = 10), and those compared with hemimandibular elongation (HE = 10) and hyperplasia (CH/HH = 10). For the evaluation of asymmetry, fluctuating asymmetry indices were calculated. Results: The fluctuating asymmetry indices did not differ between both sexes; however, they were remarkably higher in the CH groups than in HE or control. Some of the indices showing the highest differences show some potential as promising predictors for early detection of CH. Conclusions: The condylar hyperplasia shows the highest facial asymmetry among study groups and metric traits. The supraorbital-mental foramina measurement may be used for initial screening for the occurrence of condylar hyperplasia Additional measurements could increase the predictive value of this indicator. Further study on improved samples could confirm the hypothesis of facial foramina displacement influence on jaw osteotomy planning. Full article

Background/Objectives: Hemimandibular hyperplasia (HH) associated with osteochondroma presents complex challenges in maxillofacial surgery, including facial asymmetry, occlusal instability, and temporomandibular joint (TMJ) dysfunction. Surgical interventions vary widely in approach and outcomes, underscoring the need for a systematic evaluation of effectiveness. This systematic review assesses the effectiveness of surgical approaches for managing HH associated with osteochondroma, focusing on techniques including condylectomy, orthognathic surgery, distraction osteogenesis, total joint replacement (TJR), and genioplasty. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published from 2000 to 2023. Eligibility criteria were based on the PICO framework, with primary outcomes evaluated for facial symmetry, occlusal correction, mandibular function, and recurrence rates. The Cochrane Risk of Bias Tool assessed study quality, while the GRADE framework evaluated the certainty of evidence. This review was not registered due to exclusion criteria for certain dental topics in PROSPERO. Results: Of 145 studies identified, 18 met inclusion criteria, totaling 214 patients. High and low condylectomy both effectively corrected asymmetry, with high condylectomy reducing recurrence risk but often requiring reconstruction. Orthognathic surgery, combined with condylectomy, significantly enhanced facial symmetry and occlusal function. Distraction osteogenesis proved valuable for mandibular lengthening in cases of severe deformities, while TJR offered definitive solutions for extensive joint involvement. Genioplasty corrected chin asymmetry, contributing to improved facial balance. Limitations included small sample sizes and variable follow-up durations. Conclusions: Surgical approaches tailored to individual patient needs show effectiveness in treating HH associated with osteochondroma, achieving functional and esthetic outcomes. Future studies should prioritize larger cohorts and standardized follow-up protocols to better assess long-term efficacy. Advances in 3D surgical planning and individualized treatment strategies show promise for optimized patient-specific care. Full article

Hemifacial hyperplasia (HFH) is a rare congenital disorder characterized by marked unilateral overgrowth of the facial tissues. A subtype of HFH is congenital infiltrating lipomatosis of the face (CIL-F). This disease is characterized by unilateral diffuse infiltration of mature adipose cells in the facial soft tissue and is associated with skeletal hypertrophy. This work aims to report a case of a CIL-F patient with right facial asymmetry and progressive growth at adolescent age, causing mandibular asymmetry due to signs of concomitant unilateral condylar hyperplasia. At the age of seventeen, a condylectomy was performed to stop the progression of asymmetric mandibular growth. Five years later, the patient developed CIL-F-associated temporomandibular joint ankylosis, manifesting as progressive restricted mouth opening along with temporal facial pain. In this CIL-F patient, a TMJ reconstruction with an alloplastic total joint prosthesis was successfully performed with optimal maximal mouth opening, complete alleviation of temporal facial pain, and stable dental occlusion one year postoperatively. A TMJ reconstruction with a complete alloplastic total joint prosthesis proved to be a predictable, stable, and safe treatment option in a patient with CIL-F-associated TMJ ankylosis who was previously treated with condylectomy due to progressive mandibular asymmetry. Full article

Introduction. Facial asymmetry might have many etiological factors. Most known and recognized factors are related to hemimandibular hyperplasia, elongation, condyle-related pathologies hemifacial microsomia, laterogenia, and others. In some cases, however, facial asymmetry has a different origin within the maxillary sinus (MS) bones. This rare entity as a silent sinus syndrome (SSS) causes secondary midfacial and maxillary asymmetry because of the retraction of the sinus walls. The authors present their own proposal for SSS/CMA (chronic maxillary atelectasia) classification and possible maxillary sinus disease alterations related to the scope of changes in the maxillary sinus walls, asymmetry, opacification, and related features. Material and Methods. The study consisted of 131 CBCT images which were evaluated. The authors focus on fourteen retrospective cone beam-computed tomography studies (CBCT) performed to establish and evaluate sources of facial asymmetry. Results. Neither presented maxillary and facial asymmetry cases correspond to the typical SSS/CMA findings. Asymptomatic maxillary sinusitis co-existing in maxillary asymmetry cases in patients suffering from skeletal malocclusion remains atypical for SSS pure and in-pure cases. The osteomeatal complex (OMC) patency is more common for pure forms. Conclusions. Computed tomography quite easily can identify the source of the problems in the maxillary sinus and identify SSS. Coexistent chronic rhinosinusitis might correspond with another MS pathology, CMA—chronic maxillary atelectasia. The scope and the degree of MS cause midfacial asymmetry; however, the scope of sinus opacification, osteomeatal complex drainage, and occurrence of other symptoms might be more or less present. The OMC patency is more common for pure forms. Full article

Objective: To describe the position of the mandibular condyle, the size of the joint spaces and the condylar angulation in patients with facial asymmetry (FA), and to classify these results according to the type of FA and compare them with a reference group without FA. Materials and Methods/Patients: An observational, cross-sectional, descriptive study using computed tomography (CT) was conducted on a sample of 133 patients with a clinical diagnosis of FA derived from the following entities: hemimandibular elongation (HE) (n = 61), hemimandibular hyperplasia (HH) (n = 11), condylar hyperplasia in its hybrid form (HF) (n = 19), asymmetric mandibular prognathism (AMP) (n = 25), glenoid fossa asymmetry (GFA) (n = 9) and functional laterognathism (FL) (n = 8). Likewise, a group of 20 patients without clinical or tomographic characteristics of FA was taken and their complete cone beam tomography (CBCT) scans were analyzed. The quantified variables were joint spaces (anterior, middle and posterior), angle of the condylar axis and condylar position. All measurements were performed using the free, open-source Horos software. Results: Most of the subjects without FA had a right middle condylar position (55%), while in the patients with FA the anterior condylar position predominated. On the left side, the most frequent condylar position was anterior, including the group without FA, except in the HH group. Considering the measurements of the anterior, middle and posterior joint space (mm) on the right side (anterior JS: 1.9 mm, middle JS: 2 mm and posterior JS: 2.8 mm) and on the left side (anterior JS: 2.7 mm, middle JS: 2.1 mm and posterior JS: 2.6 mm) of the subjects without FA, compared to those with FA, the latter presented smaller distances in all diagnoses and only for the right posterior JS (1.9 mm) in HH, was not significant. The condylar axis of the AF group showed significant differences with smaller angles for the left side in those diagnosed with HE (65.4°) and HH (56.5°) compared to those without AF (70.4°). Conclusions: The condylar position of patients with FA tends to be anterior, both on the right and left sides, while for cases without FA it is middle and anterior, respectively. Patients with FA have smaller joint spaces (mm) compared to patients without FA, with the exception of HH for the right posterior JS. Full article

Nowadays, maxillo-facial surgery procedures are greatly dependent on good general anesthesia and adequate maintenance care of the airways. Nasotracheal intubation (NTI) is one of the most common ones, especially in orthognathic surgery, temporomandibular joint-related surgeries, or others. Nasotracheal intubation itself is not a problem; however, maintaining its stable and safe position, regardless of the excess of surgical maneuvers in the facial skeleton, is important. There are a lot of techniques, personal modifications, and materials used to support tube placement. It is quite common that either plaster or a bandage roll can be useful with a combination of various forms of sponges or wipes in different shapes, sizes, and elasticity to support the tube’s adequate position, especially when maintaining a good shape and position of the nose and symmetry line and avoiding unnecessary tube flexion. In the following paper, one of the tube support alternatives with an anti-bedsore heel disc will be presented. Full article

In order to fully evaluate and establish the degree of bone overgrowth, various radiological studies are essential in the careful planning of the amount of surgical excision. In the presented paper, the authors use self-designed anatomo-topographical reference points for planning the surgeries. Routine panoramic radiographs and low-dose computed tomography based on anatomical landmarks help in measuring the proportions of mandibular bone overgrowth with the following preoperative anatomical landmarks: (Go-Go), (Go(Right)-Gn), (Go(Left)-Gn), and (Me–Gn). Measurements taken at selected points and landmarks (gonion-gnathion/gnathion-menton) are easy to conduct. In the authors’ proposal, the main key factor is total chin correction, which is necessary in cases of severe overgrowth; when F0 > C and Go-Gn>, there is >7 mm of vertical bone overgrowth, and the mandibular canal is positioned <5 mm from the inferior mandibular border—MIB. Larger overgrowths (>7 mm) have a greater outcome on the final symmetry than smaller overgrowths. As no guidelines are known, the authors present their own proposal. Full article

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. Full article

Hemimandibular hyperplasia (HH) and elongation (HE) are the most common pathologies present in the mandible. Presented condylar hyperplasias have their own radiological and clinical features. In most cases, patients suffer from various forms of malocclusion. From a total of 150 asymmetrical jaw radiographs evaluated, 46 were evaluated and included in this study. A retrospective study on the data of 46 selected patients treated, diagnosed, and consulted from various forms of mandibular and skeletal asymmetry based on routine diagnostic panoramic radiographs evaluated typical and atypical radiological and anatomical symptoms of condylar hyperplasia. The presented evaluation focused on mandibular, maxillary, and other bones, in order to distinguish condylar hyperplasia from other forms of mandibular asymmetry. The degree of maxillary downward growth followed by the occurrence of an open bite on the affected side estimate the degree/presence or cessation of growth in the affected condyle. Mandibular asymmetry with incisor teeth inclination remains the most typical characteristic of condylar hyperplasia. Increased height of mandibular ramus differentiates between condylar hyperplasia and elongation, which also influences the position of the inferior alveolar nerve. Mentioned symptoms, described as the acronym “Go Moira!”, are useful in a quick and simple “glimpse of an eye” differential diagnostic approach. It is possible to quickly and accurately establish the first diagnosis simply by a careful evaluation of patients’ panoramic radiographs. Full article

A 32-year-old man was referred to the Division of Orthodontics of the University of Naples “Federico II”, with a 15-year history of gradually increasing right-sided facial asymmetry. Clinical and radiological examinations was consistent to hemimandibular hyperplasia, a rare developmental asymmetry characterized by three-dimensional enlargement of one-half of the mandible. The standard surgical-orthodontic management was proposed to the patient. However, he refused to undergo bimaxillary orthognatic surgery. Therefore, a different treatment was proposed based on the orthodontic technique of pre-surgical decompensation and post-surgical refinement used in bimaxillary orthognatic surgery planning, and surgical intervention with a condylectomy. The dental arches were evenly levelled out with a multi-bracket treatment and then the condylectomy was performed. Orthodontic treatment continued with a levelling and torque control by 0.19 × 0.25 SS arch and physiotherapy. At the three-month follow-up, the patient showed anterior and posterior bite rebalancing, arch intercuspation recovery, and anterior open bite closure due to muscular self-rebalancing. The two-year follow-up showed regular mandibular dynamic, orthodontic appliances were removed, and the patient was instructed to wear retainer for the following months. The final result was aesthetically reasonable for the patient, although slight asymmetry of the chin persisted. Full article