Search Results (24)

Background: Unilateral progressive condylar growth (UPCG) represents a complex clinical condition characterized by abnormal enlargement of the mandibular condyle, leading to progressive facial asymmetry and functional impairment. Objectives: The aim of this review is to analyze the biological, clinical, and therapeutic factors guiding condylectomy, assess the current role and scope of proportional condylectomy, and propose an algorithm to guide its indication in patients with UPCG. Methods: A narrative review was conducted to analyze the biological, clinical, and therapeutic factors involved in the indication for condylectomy in patients with progressive unilateral condylar growth. Studies including patients diagnosed with unilateral condylar hyperplasia or condylar osteochondroma who underwent surgical treatment were considered to evaluate clinical indications, timing of intervention, and outcomes. Special attention was given to the concept of proportional condylectomy. Results: Current evidence indicates that early intervention may control disease progression, reduce the severity of residual deformity, and minimize the need for secondary orthognathic surgery. The integration of clinical findings, three-dimensional imaging, and patient-specific factors is essential for appropriate treatment planning. Conclusions: Based on these considerations, a structured clinical algorithm is proposed to guide decision-making in patients with unilateral progressive condylar growth. This approach supports individualized treatment strategies aimed at optimizing functional and esthetic outcomes. Full article

In condylar hyperplasia (CH), one of the condylar processes of the mandible (CPs) grows more than its counterpart, leading to facial asymmetry. Using a mouse model of asymmetric masticatory loading, we investigated a possible mechanical origin of CH by evaluating the association between morphometric parameters of CP cartilage and bone and the mandibular load regime. Thirty-nine adult male and female mouse hemimandibles that underwent different loading regimes were used: underloaded (UL), overloaded (OL), and symmetrically loaded (SL) controls. Micro-CTs were used to assess macroscopic shape and trabecular bone (TB) parameters, and articular cartilage features were studied histologically. Data were compared using multivariate and pairwise statistics. Principal component analysis showed that OL CPs exhibit a wide range of shape variation and show thicker cartilage but display TB features indicative of ongoing remodeling. Female OL tended to show more variable and larger parameters than males. However, differences in traits between sexes and load groups were not always statistically significant. We conclude that an asymmetric increase in mandibular loading may be associated with changes in the macro-/microscopic structure of the CP, affecting males and females differently. Signs of cartilage growth and bone remodeling are found in OL individuals, which are compatible with CH features. Full article

Advanced cases of unilateral condylar hyperplasia might need combined joint reconstruction and orthognathic surgery. This report illustrates the feasibility of integrating digital planning, patient-specific prosthesis design, and orthognathic correction within a single-stage surgical workflow. A 23-year-old female patient presented with skeletal Class III malocclusion, facial asymmetry, and mandibular midline deviation due to left condylar hyperplasia. After preoperative orthodontic alignment, virtual surgical planning was carried out using specialised software to simulate resection of the hyperplastic condyle, with concurrent total TMJ replacement, contralateral sagittal split ramus osteotomy, and Le Fort I osteotomy. Based on this plan, patient-specific prosthetic components, surgical guides, and fixation plates were designed and manufactured. Surgery was performed according to the digital plan using a combined intraoral and extraoral approach. At 3-month follow-up, clinical and radiological assessments showed stable prosthesis positioning, improved occlusal relationships, restoration of facial symmetry, and high patient-reported satisfaction. However, given the single-case design and short follow-up, these findings should be considered preliminary, and further studies are necessary to evaluate long-term functional outcomes and reproducibility. Full article

Background/Objectives: Unilateral condylar hyperplasia is an idiopathic condition that causes facial asymmetry and occlusal problems. Currently, traditional treatment protocol is the combination of orthognathic and extra-oral condylectomy surgery via pre-auricular incision, which can create aesthetic problems with additional risks of facial nerve damage. The purpose of this study was to report management of condylar hyperplasia patients through minimally invasive condylectomy that was planned via virtual methods. Methods: The custom-made cutting guides were produced, and unilateral condylectomy operations were performed via intra-oral approach. Orthognathic surgery with/without genioplasty operations were either done with condylectomy in one session or in an additional session. Results: Custom-made cutting guides produced by virtual methods provided easy operations without any need for additional extra-oral incisions. Planned osteotomies were transferred successfully from the virtual surgical plan and resections of the excess bone tissues were performed using novel piezo surgery devices. The bones were fixed to their pre-planned position using 3D-printed titanium plates. The patients healed without any complications. Results of this innovative virtually guided protocol tested showed functional and esthetic results without any extra-oral scars with no facial nerve damage. Conclusions: Combination of intra-oral condylectomy with orthognathic surgery using 3D-printed titanium cutting guides seems to be an advantageous approach with successful results in terms of aesthetics and function for management of mandibular condylar hyperplasia patients; however, there is an urgent need in the scientific literature for further clinical research with a larger number of subjects. Full article

Objective: To evaluate the three-dimensional (3D) angular displacement (Roll, Yaw, and Pitch) of the upper cervical vertebrae (C1, C2, and C3) in patients with severe mandibular deviation (MD) due to condylar hyperplasia (CH), utilizing a computed tomography (CT)-based segmentation approach. Methods: This retrospective cross-sectional study included 50 patients with MD ≥ 6 mm caused by hemimandibular elongation (HE) or a hybrid form (HF) of CH. The skull, mandible, and cervical vertebrae (C1–C3) were segmented using 3D Slicer software. Angular deviations (Pitch, Yaw, Roll) were measured relative to the Frankfurt plane. Patients were categorized by the side of CH (right or left), and intergroup comparisons were performed using Kruskal–Wallis and Mann–Whitney U tests. Spearman’s correlation analyses assessed associations between MD magnitude and cervical angles. Results: CH was significantly more prevalent in females (58%; p = 0.021). C2 and C3 exhibited significantly increased lateral Roll inclination toward the side of deviation (p = 0.006 and p = 0.045, respectively). C2 Pitch negatively correlated with MD severity bilaterally (r ≈ −0.51, p = 0.02 right; r ≈ −0.50, p = 0.02 left). Strong intra-vertebral correlations between Pitch and Yaw were observed in C1 and C2, indicating synchronized vertical and rotational motion. No significant intergroup differences were found in Yaw angles (p > 0.05). Conclusions: Patients with CH and severe MD exhibit consistent patterns of 3D cervical displacement, particularly in lateral inclination and vertical movement, suggesting compensatory postural adaptations in the upper cervical spine. Full article

Unilateral condylar hyperplasia (UCH) is one of the causes of facial asymmetry, and it is characterized by increased growth in one of the mandibular condyles. In UCH, it is important to determine whether the metabolic activity of the hyperplastic condyle is still active. Fractal dimension (FD) analysis could be a non-invasive method to identify active metabolic activity. The aim of this study is to compare the FD of the hyperplastic condyle with the contralateral one in patients with facial asymmetry and positive bone scintigraphy and to compare the FD of the right and left condyles in symmetrical patients. A cross-sectional retrospective study of fifteen patients with facial asymmetry and positive bone scintigraphy and fifteen symmetrical patients was conducted. Clinical data and scintigraphy results were collected from medical records, and CBCT scans were used for the application of FD by pre-processing the images according to White and Rudolph and using ImageJ^® (1.54p) software and the box-counting method. Wilcoxon’s t test was used to analyze the differences in FD between the hyperplastic and contralateral condyles in patients with UCH and between the right and left condyles in symmetrical patients. A p-value of <0.05 was considered statistically significant. The FD of the hyperplastic condyles was significantly higher than the contralateral one in the axial and coronal plane (p = 0.001). The analysis of FD of the mandibular condyle can be a useful non-invasive method to identify active UCH in patients with facial asymmetry. Full article

Background: Condylar hyperplasia (CH) leads to mandibular overgrowth with anatomical, aesthetic, and functional consequences, particularly affecting facial harmony. It is characterized by severe mandibular prognathism (MP) in bilateral cases. This study aims to propose a therapeutic algorithm for diagnosing and treating bilateral condylar hyperplasia (BCH) based on demographic, clinical, craniofacial growth, and clivus ratio uptake conditions. Methods: Ten patients with severe skeletal Class III by MP, whose alteration was clinically associated with BCH, were consecutively evaluated in a specialized dentofacial deformity center between the period of 2019 and 2024. A detailed protocol was followed to gather clinical history, assess anatomical features, evaluate malocclusion, and identify potential BCH. When suspicion arose, a nuclear medicine test measured condylar scintigraphy uptake. If the result was positive, patients underwent bilateral condylectomy, following one of three treatment protocols. Results: Severe PM, pronounced Class III with excessive negative overjet, elongated condyles of normal anatomy, absence of family history, and accelerated growth since preadolescence and adolescence were common characteristics in these patients. Regarding the treatment protocol chosen according to the characteristics of the patients, five cases followed treatment protocol A: condylectomy and surgical correction of the alteration in two surgical stages. Two cases followed protocol B: bilateral condylectomy and orthognathic surgery in the same surgical time, and three cases followed protocol C: condylectomy and later post-surgical orthopedics and/or orthodontics without a second surgical intervention. Histopathological results confirmed bilateral hyperplastic growth and stability in mandibular size, and occlusion was observed during follow-up. Conclusions: Specialists need to recognize the clinical signs of BCH and use scintigraphy tests to measure condylar metabolic activity when suspected. Early detection of BCH is crucial, as it influences treatment decisions and helps prevent relapses in orthodontic or surgical interventions aimed solely at correcting or compensating for Class III malocclusion caused by MP. Full article

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

Class III patients have classically been managed through monomaxillary techniques, mainly involving mandibular setback movements. More recently, according to the upper incisor to soft tissue plane (UI-STP) or Barcelona Line (BL) planning protocol, bimaxillary procedures for upper maxilla advancement and reduced mandibular setback have been recommended in order to secure better aesthetic outcomes and avoid upper airway constriction. The present study describes the jaw movements in the sagittal plane performed in class III patients subjected to bimaxillary surgery following the BL protocol. A retrospective evaluation was performed on 124 class III patients subjected to bimaxillary surgery. All subjects underwent upper maxilla advancement. A total of 112 patients received mandible advancement movement (90.3%), nine received mandibular setback (7.25%), and the mandible underwent no movement along the sagittal dimension in the three remaining patients (2.4%). Mandibular advancement was significantly the most frequent treatment option. The presented results suggest that when the BL planning protocol is used as an aesthetic and functional reference, class III occlusion appears mostly related to maxillary sagittal hypoplasia instead of mandible hyperplasia, so bimaxillary advancement surgery should be considered as one of the first-choice procedures for the treatment of these patients. 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

Background: Unilateral condylar hyperplasia (UCH) is characterized by slow progression and enlargement of the condyle, accompanied by elongation of the mandibular body, resulting in facial asymmetry, occlusal disharmony, and joint dysfunction. This condition can be defined as “active” or “inactive”: the active form is characterized by continuous growth and dynamic histologic changes, whereas the inactive form indicates that the growth process has stabilized. Since there are few microscopic studies on the inactive form, this study aims to investigate the histological features and expression of key proteins and bone markers in patients diagnosed with inactive UCH. Methods: A total of 15 biopsies from patients aged 28 to 36 years were examined by light microscopy and immunofluorescence for collagen I and II, metalloproteinases 2 (MMP-2) and 9 (MMP-9), receptor activator of nuclear factor- kappa B (RANK), and osteocalcin. Results: Our findings indicate that during inactive UCH, the ongoing process is not entirely stopped, with moderate expression of collagen, metalloproteinases, RANK, and osteocalcin, although no cartilage islands are detectable. Conclusions: The present study shows that even if these features are moderate when compared to active UCH and without cartilage islands, inactive UCH could be characterized by borderline features that could represent an important trigger-point to possible reactivation, or they could represent a long slow progression that is not “self-limited”. Full article

Unilateral condylar hyperplasia (UCH) is a rare cause of asymmetrical mandibular overgrowth because of the presence of an atypical growth in the affected condyle. SPECT (single-photon emission computed tomography) can easily establish the presence of an atypical, prolonged growth exceeding far beyond normal condylar growth and activity. A CT, CBCT, or LDCT (computed tomography, cone-beam computed tomography, or low-dose computed tomography) can confirm the diagnosis by evaluating the scope of bone overgrowth, mandibular basis/ramus asymmetry, tendency to condylar head enlargement, changes in bone density, and occurrence of differences in condylar head shapes, size, and bone structure. In most cases, a condylectomy is the procedure of choice in growing cases of UCH to remove the pathological condyle and reduce asymmetry levels. Sometimes, the growth is very slow and progressive over time, causing slowly growing asymmetry with similar symptoms to any other mandibular asymmetry, and this causes some troublesome procedures in UCH diagnostics, resulting in patients being underdiagnosed; it can even lead to some relapses in mandibular asymmetry and skeletal malocclusion after previously performed orthodontic and surgical treatment of such discrepancies. When the source of asymmetry is not identified in time, possible inadequate treatment protocols can be used. If any relapse of facial and mandibular asymmetry re-occur, SPECT and CT evaluation are necessary to evaluate if condylar hyperplasia is present and to establish what kind of surgical intervention should be used in each case. 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

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