Unilateral condylar hyperplasia: a thee-dimensional CBCT morphometric and volumetric evaluation of mandibular condyle by open-source softwares / Hiperplasia condilar unilateral: evaluación morfométrica y volumétrica en TCHC tridimensional del cóndilo mandibular mediante softwares de código abierto

SUMMARY: Unilateral condylar hyperplasia (UCH) is an alteration of the mandibular condyle growth. The aim of this study was to evaluate condyle volume, surface area, and Morphological Index (MI) differences between the affected condyle and an unaffected one in patients with UCH, evaluated through 3D reconstructions cone beam computed tomography (CBCT) images by two open-source softwares. A retrospective cross-sectional study of 16 patients with a certain UCH, 9 females and 7 males with mean age 25.13 ± 6.8 years was made. The image obtained from the CBCT of each condyle were reconstructed using the open-source software 3D SLICER 4.6 ®. The volumetric and area measurements of the 3D reconstruction of the mandibular condyle were made using the open-source soft- ware NETFABB basic 5.0 ®. The mean condylar volume of the hyperplastic condyles was 2.07 ± 1.51 cm3 and the non-hyperplastic condyles was 1.16 ± 0.82 cm3 (p<0.05). The mean area surface of the hyperplastic condyle was 11.77 ± 3.71 cm2 and the non-hyperplasic condyle mean was 8.05 ± 2.17 cm2 (p < 0.05). The mean area surface difference was 3.72 ± 3.57 cm2 (28.0 %). The MI of the hyperplastic condyle was 1.8 ± 0.3 mm and the non-affected condyle was 1.3 ± 0.6 mm (p < 0.05). The use of open-source software for 3D reconstruction with manual segmentation for evaluation of the volume and the condylar surface is a valid tool available to the clinic in the diagnosis and monitoring of patients with condylar hyperplasia.

RESUMEN: La hiperplasia condilar unilateral (HU) es una alteración del crecimiento del cóndilo mandibular. El objetivo de este estudio fue evaluar en pacientes el volumen del cóndilo, el área de superficie y las diferencias del índice morfológico (IM) entre el cóndilo afectado y el no afectado en pacientes, mediante tomografía computarizada de haz cónico (TCHC), por medio de dos softwares. Se realizó un estudio transversal retrospectivo de 16 pacientes con determinada HU, 9 mujeres y 7 hombres con edad media 25,13 ± 6,8 años. La imagen obtenida del TCHC de cada cóndilo se reconstruyó utilizando el software de código abierto 3D SLICER 4.6 ®. Las medidas volumétricas y de área de la reconstrucción 3D del cóndilo mandibular se realizaron utilizando el software de código abierto NETFABB basic 5.0 ®. El volumen condilar medio de los cóndilos hiperplásicos fue de 2,07 ± 1,51 cm3 y el de los cóndilos no hiperplásicos fue de 1,16 ± 0,82 cm3 (p <0,05). La superficie media del cóndilo hiperplásico fue de 11,77 ± 3,71 cm2 y la media del cóndilo no hiperplásico fue 8,05 ± 2,17 cm2 (p <0,05). La diferencia de superficie de área media fue 3,72 ± 3,57 cm2 (28,0 %). El IM del cóndilo hiperplásico fue de 1,8 ± 0,3 mm y el cóndilo no afectado fue de 1,3 ± 0,6 mm (p <0,05). Para el clínico, el uso de software de código abierto en la reconstrucción 3D con segmentación manual, para la evaluación del volumen y la superficie condilar, es una herramienta efectiva en el diagnóstico y tratamiento de pacientes con hiperplasia condilar.

Correção de Hiperplasia Hemimandibular com cirurgia de estágio único e uso de prototipagem: relato de caso / Correction of Hemimandibular Hyperplasia with single-stage surgery and use of prototyping: Case Report

Introdução:O tratamento da assimetria facial causada pela hiperplasia hemimandibularvemsendodebatidohádécadase, ainda assim,existem algumas controvérsias quanto aomelhor manejo dessacondição. Relato de caso:Revisão de literatura acerca das abordagens cirúrgicas descritas, e, apresentação de caso clínico de uma pacientecomassimetriafacial. Foram realizadas a cirurgiadepredictibil idadenoarticuladorsemi-ajustáveleprototipagem dos maxilares feita a partir de tomografia computadorizada. A paciente foi submetida a cirurgia ortognática com nivelamento da basilar mandibular e condilectomia no mesmo tempo cirúrgico. Considerações finais:Após acompanhamento por 48 meses, a paciente não apresenta recidiva e segue com a oclusão estável. Segue, também, sem dor nas articulações temporomandibulares. Dessaforma, foi alcançado um aspecto mais harmonioso da face, uma vez que a paciente se queixava de que a assimetria causava transtornos sociais a ela... (AU)

Introduction: The treatment of facial asymmetry caused by hemimandibular hyperplasia has been debated for decades and, even so, there are some controversies regarding the best management of this condition. Case report: Literature review about the surgical approaches described, and presentation of a clinical case of a patient with facial asymmetry. Predictability surgery was performed on the semi-adjustable articulator and prototyping of the jaws using computed tomography. The patient underwent orthognathic surgery with leveling of the mandibular basilar and condylectomy at the same surgical time. Final considerations: After 48 months of follow-up, the patient has no recurrence and continues with stable occlusion. There is also no pain in the temporomandibular joints. In this way, a more harmonious aspect of the face was achieved, since the patient complained that the asymmetry caused social disorders to her... (AU)

Mandibular and temporomandibular morphologic characteristics of patients with suspected unilateral condylar hyperplasia: a CT study

ABSTRACT Introduction: Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a complicated clinical condition. Objective: The objective of this study was to describe morphological characteristics of the mandible and the temporomandibular joint in patients with facial asymmetry, using computed tomography and 3D reconstruction. Methods: A retrospective observational study was performed with patients displaying facial asymmetry evaluated by single photon emission computed tomography (SPECT)/CT analysis, for suspected UCH, between 2015 and 2018. The following variables were compared between the affected side (producing the asymmetry) and the contralateral side (side to where the jaw is deflected): condylar length, condylar medial and lateral pole length, mandibular ramus length, intra-articular spaces, articular eminence height and position of the posterior wall of the glenoid fossa. Results: Forty-three patients (21 women, mean age: 20.7 ± 7.25 years) with facial asymmetry were included, 19 patients presented right side deviation and 24 patients had left side deviation. Condylar length, lateral pole length, the sum of maximum values and articular eminence height were greater in the affected side (p< 0.05). A positive correlation was found between the position of the posterior wall of the glenoid fossa and the articular eminence height in the affected side (r = 0.442). Conclusions: In patients with suspected UCH, evaluated through CT, craniofacial measurements showed significantly larger condylar length and the condylar sum of maximum values in the affected side. A positive correlation was found between the increased dimensions of the articular eminence and the more posterior position of the glenoid fossa in the affected side.

RESUMO Introdução: A assimetria facial associada à hiperplasia condilar unilateral (HCU) é uma condição clínica complexa. Objetivo: O objetivo desse estudo foi descrever as características morfológicas da mandíbula e da articulação temporomandibular de pacientes com assimetria facial, usando tomografia computadorizada e reconstruções tridimensionais. Métodos: Esse estudo observacional retrospectivo foi realizado em pacientes com assimetria facial e suspeita de HCU, avaliados por meio da análise de tomografia computadorizada de emissão de fóton único (SPECT)/TC, entre os anos de 2015 e 2018. As seguintes variáveis foram comparadas entre o lado afetado (responsável pela assimetria) e o lado contralateral (lado para onde a arcada estava desviada): comprimento condilar, comprimento dos polos medial e lateral do côndilo, comprimento do ramo mandibular, espaços intra-articulares, altura da eminência articular e posição da parede posterior da fossa glenoide. Resultados: A amostra constituiu-se de 43 pacientes (21 mulheres, idade média: 20,7 ? 7,25 anos) com assimetria facial, da qual 19 pacientes apresentavam desvio do lado direito e 24, do lado esquerdo. O comprimento condilar, o comprimento do polo lateral, a soma dos valores máximos e a altura da eminência articular foram maiores no lado afetado (p< 0,05). Foi encontrada uma correlação positiva entre a posição da parede posterior da fossa glenoide e a altura da eminência articular no lado afetado (r = 0,442). Conclusão: Em pacientes com suspeita de HCU, avaliados por meio de TC, as medidas craniofaciais mostraram um comprimento condilar e a soma dos valores condilares máximos significativamente maiores no lado afetado. Foi encontrada uma correlação positiva entre as dimensões aumentadas da eminência articular e a posição mais posterior da fossa glenoide no lado afetado.

Manejo Quirúrgico de la Hiperplasia Condilar Tipo 2: Reporte de un Caso / Surgical Management of Mandibular Condylar Hyperplasia Type 2: Case Report

RESUMEN: La hiperplasia condilar (HC) es un término genérico de una condición patológica que se utiliza para describir situaciones que causan el crecimiento excesivo y sobredesarrollo del cóndilo mandibular, repercutiendo así también en la mandíbula, es la responsable de alrededor del 50 % de las asimetrías faciales y se presenta con mayor frecuencia entre los 11 y 30 años de edad. Se presenta un caso clínico de una paciente femenina de 21 años de edad que presentaba hiperplasia condilar unilateral izquierda con compensación alveolodentaria. Se realizó condilectomía alta con abordaje endoaural para retirar 5 mm de la parte superior del cóndilo y osteotomía mandibular mediante abordaje intraoral circunvestibular, con disección y preservación del nervio dentario inferior, retirando 8 mm del aspecto inferior de la mandíbula de acuerdo a los requerimientos estéticos. El brindar un tratamiento adecuado a la hiperplasia condilar enfocado a corregir las secuelas tanto funcionales como estéticas es de gran beneficio al paciente ya que le permite mejorar su calidad de vida, el correcto diagnóstico es vital para poder planear un tratamiento exitoso.

ABSTRACT: Condylar hyperplasia (CH) is a generic term for a pathological situation that is used to describe conditions that cause excessive growth and overdevelopment of the mandibular condyle and also impacting on the jaw, this bone formation is responsible about of 50 % of all deformities facial and it occurs most frequently between 11-30 years old. This case report is about a 21-years old female who showed unilateral condylar hyperplasia of left side with alveolodentary compensatory. Was carried out high condilectomy through an endoaural approach removing 5 mm of the upper condyle and the mandibular osteotomy was performed through intraoral approach with dissection and preservation of the inferior alveolar nerve, removing 8 mm of the inferior aspect of the mandible according to the aesthetic requirements. An appropriate treatment for the condylar hyperplasia focused on correcting the side effects such as functional or aesthetic it's of great benefit for the patient because it allows improve their quality of life. A correct diagnosis is very important to planning a successful treatment.

Orthodontic treatment with the meaw technique following high condylectomy for the treatment of condylar hyperplasia: case series / Ortodoncia con técnica meaw posterior a condilectomía alta para el tratamiento de la hiperplasia condilar: serie de casos

ABSTRACT Unilateral condylar hyperplasia (UCH) is a pathological condition affecting not only facial appearance and occlusal relationships, but also mandibular joints health. The accurate and timely diagnosis, along with a therapeutic work and a multidisciplinary approach, help reduce the morphological alterations caused by this pathology. Orthodontics plays an important role in the various treatment modalities because of its role not only in presurgical dentoalveolar decompensation but also in dentoalveolar compensation with vertical management when the asymmetry allows it. The following therapeutic proposal describes the treatment of patients with active UCH subjected to high condylectomy surgery immediately after orthodontic dentoalveolar compensation with Multi-Loop Edgewise Archwire (MEAW) for the vertical handling of occlusal canting and maintenance of the orthopedic position of the mandible. All cases were satisfactorily resolved with the same diagnostic and treatment protocol. The conclusion is that, with adequate diagnosis and orthodontic management following condylectomy, non-severe cases of UCH may be treated.

RESUMEN La hiperplasia condilar unilateral (HCU) es una condición patológica que compromete tanto la estética facial como la relación oclusal y la salud articular. El diagnóstico correcto y oportuno, junto al abordaje terapéutico con un enfoque multidisciplinario, contribuyen a minimizar las alteraciones morfológicas que deja esta patología. La ortodoncia juega un papel importante en las diferentes modalidades de tratamiento, ya sea por su papel en la descompensación dentoalveolar prequirúrgica o en la compensación dentoalveolar con manejo vertical cuando la asimetría lo permite. La siguiente propuesta terapéutica muestra el abordaje de pacientes con HCU activa sometidos a cirugía de condilectomía alta, quienes inmediatamente después recibieron una compensación ortodóncica dentoalveolar con técnica modificada de arco de canto multiansas (MEAW) para el manejo vertical del canteamiento de la oclusión y el mantenimiento de la orto-posición de la mandíbula. Todos los casos se resolvieron de manera satisfactoria con el mismo protocolo diagnóstico y de tratamiento. Concluimos que, con un diagnóstico adecuado y un manejo ortodóncico posterior a condilectomía, se pueden tratar casos no severos de HCU.

Condilectomia alta associada à discopexia, com âncoras, no tratamento da hiperplasia condilar: relato de caso / Highcondilectomy associated to discopexy with anchor for conylar hyperplasia treatment: a case report

Introdução: A hiperplasia condilar (HC) é uma patologia rara caracterizada por crescimento não neoplásico que afeta a morfologia do côndilo mandibular com deformação progressiva. Dentre os sinais mais comuns destacam-se a assimetria facial e mandibular, além de possíveis alterações oclusais como mordida aberta ipsilateral e transversal contralateral. A combinação de exames clínicos com a análise de modelos de gesso, fotografias, radiografias panorâmicas, cintilografias e cefalogramas são essenciais para definição do correto diagnóstico. Objetivo: O objetivo do estudo foi demonstrar a eficácia terapêutica da condilectomia alta no tratamento da hiperplasia condilar. Relato de caso: paciente jovem, 24 anos de idade, apresentando assimetria facial, déficit e incompetência funcional mastigatória, mordida aberta posterior ipsilateral e mordida cruzada posterior contralateral. A proposta terapêutica escolhida foi o tratamento cirúrgico com condilectomia alta e discopexia com âncora para estabilização do disco articular, através de acesso endaural para o côndilo afetado. Conclusão: A condilectomia alta preveniu a deformidade facial progressiva, minimizando as sequelas funcionais e estéticas, favorecendo o tratamento das deformidades faciais.

Introduction: Condylar hyperplasia is a rare disorder characterized by a non-neoplastic pathological growth that affects the morphology of the mandibular with progressive deformation. Clinical examination, plaster model's analysis, clinical photographs, panoramic radiography, scintigraphyandcephalograms in combination are essential to make a correct diagnosis. Among the most common signs and symptoms of the condition are facial and mandibular asymmetry, and occlusal changes such as contralateral ipsilateral and cross open bite. Objective: The aim of the study was to describe the efficacy of high condilectomy in the treatment of condylar hyperplasia. Relato de caso: Young patient, 24 years-old, presenting facial asymmetry, functional masticatory deficit and functional incompetence, ipsilateral posterior open bite and contralateral posterior crossbite. The therapeutic proposal chosen was the surgical treatment with high condilectomy and discopexy with anchor for stabilization of the articular disc through endaural access to the affected condyle. Conclusion: The high condylectomy, prevents progressive facial deformity minimizing the functional and aesthetic sequelae, which favors the treatment of facial deformities.

Condylectomy and "surgery first" approach: An expedited treatment for condylar hyperplasia in a patient with facial asymmetry

ABSTRACT Condylar Hyperplasia (CH) is a self-limiting pathology condition that produces severe facial deformity at the expense of mandibular asymmetry. In this case report a 15-year-old female patient was diagnosed with Unilateral Condylar Hiperplasia (UCH) by mean of single-photon emission computed tomography (SPECT) and histological study. A high condylectomy in the right condyle was performed to stop the active status of the hyperplasia. A month after condylectomy, orthognathic jaw impaction and asymmetric mandibular setback surgery was performed with the Surgery First Approach (SFA). After 10 days, orthodontic appointments were made every two weeks during 4 months. The active phase of treatment lasted 14 months. Excellent facial and occlusal outcomes were obtained and after 24 months in retention the results remained stable.

RESUMO A hiperplasia condilar (HC) é uma condição patológica autolimitante que produz deformidades faciais severas devido à assimetria mandibular. Nesse estudo de caso, uma paciente de 15 anos de idade foi diagnosticada com hiperplasia condilar unilateral (HCU), por meio de uma tomografia computadorizada por emissão de fóton único (SPECT) e de um estudo histológico. Uma condilectomia alta no côndilo direito foi realizada para interromper o status ativo da hiperplasia. Um mês após o procedimento, foram realizadas a impacção ortognática de maxilar e a cirurgia de retroposicionamento assimétrico da mandíbula, por meio de abordagem do tipo benefício antecipado. Depois de 10 dias, consultas ortodônticas passaram a ser feitas a cada duas semanas, durante 4 meses. A fase ativa do tratamento durou 14 meses. Excelentes resultados oclusais e faciais foram obtidos e, após 24 meses de contenção, os resultados permaneceram estáveis.

Unilateral Mandibular Condylar Hyperplasia

Mandibular condylar hyperplasia is a relatively rare condition with uncertain etiology affecting the condylar head, neck and many a times body and ramus of mandible. The condition causes facial asymmetry, deviation of the jaw, occlusal derangements and articular dysfunction. Radiographic examination plays a critical role in establishing a correct diagnosis. Bone scintigraphy scan has been found to be effective in direct assessment of condyar activity which aids in proper treatment planning. Here, we report a case of unilateral condylar hyperplasia in a 31year old male patient which was diagnosed and corrected with the help of appropriate radiographic examination.

Unilateral Mandibular Condylar Hyperplasia

Mandibular condylar hyperplasia is a relatively rare condition with uncertain etiology affecting the condylar head, neck and many a times body and ramus of mandible. The condition causes facial asymmetry, deviation of the jaw, occlusal derangements and articular dysfunction. Radiographic examination plays a critical role in establishing a correct diagnosis. Bone scintigraphy scan has been found to be effective in direct assessment of condyar activity which aids in proper treatment planning. Here, we report a case of unilateral condylar hyperplasia in a 31year old male patient which was diagnosed and corrected with the help of appropriate radiographic examination.

Surgical Treatment of Condylar Hyperplasia Associated with Dentofacial Deformity: Low Condylectomy, Articular Disc Repositioning, and Orthognathic Surgery / Tratamiento Quirúrgico de Hiperplasia Condilar Asociado a la Deformidad Dentofacial: Condilectomía Baja, Reposicionamiento del Disco Articular y Cirugía Ortognática

Due to the complexity of the treatment of condylar hyperplasia associated with dentofacial deformities and its complications, if left untreated, the surgeon should be alert to these factors at the time of surgical planning to tailor the optimal therapy for an individual patient. This case report describes a patient with right condylar hyperplasia associated with dentofacial deformity who was treated surgically with low condylectomy, articular disc repositioning and anchoring, and orthognathic surgery, concomitantly, with stable results, satisfactory occlusion and facial harmony.

Debido a la complejidad del tratamiento de la hiperplasia condilar asociada con deformidades dentofaciales y sus complicaciones, si no se trata, el cirujano debe estar alerta ante estos factores en el momento de la planificación quirúrgica para adaptar la terapia óptima para cada paciente. Este caso describe un paciente con hiperplasia condilar derecha asociada con la deformidad dentofacial que fue tratado quirúrgicamente con condilectomía baja, reposicionamiento y anclaje del disco articular, y la cirugía ortognática, concomitantemente, con resultados estables, oclusión satisfactoria y armonía facial.

Hiperplasia condilar: características, manifestaciones, diagnóstico y tratamiento. Revisión de tema / Condylar hyperplasia: characteristics, manifestations, diagnosis and treatment. A topic review

La hiperplasia condilar es una patología que no solo afecta las proporciones y la simetría facial en los pacientes, sino que también afecta la función estática y dinámica de la oclusión con repercusiones en la actividad masticatoria, la salud de la articulación temporomandibular (ATM) y la anatomía y volumen de los tejidos blandos adyacentes. Por lo tanto, es una entidad que, según su severidad, compete a cirujanos maxilofaciales, ortodoncistas, fisioterapeutas, cirujanos plásticos y médicos nucleares, quienes están muy relacionados en la etapa de diagnóstico. Históricamente, el diagnóstico de hiperplasia condilar se ha basado en la anamnesis y el examen físico inicial del paciente, en donde se detectan la asimetría, la maloclusión y en algunos casos desórdenes temporomandibulares (DTM), que luego son corroborados con exámenes como la gammagrafía ósea y, finalmente, por el informe de patología después de que la cirugía condilar se ha realizado. El propósito de esta revisión bibliográfica, es conocer de manera detallada el comportamiento de esta patología desde el punto de vista de su etiología, sus características clínicas, su distribución por edad, sexo y cóndilo afectado, así como las ayudas diagnósticas e imagenológicas necesarias para su diagnóstico, las enfermedades asociadas y su diagnóstico diferencial, las características histológicas del tejido afectado y sus diferentes abordajes terapéuticos según la severidad, la edad del paciente y la patología en su forma activa o inactiva. La información se obtuvo de artículos de investigación científica, publicados en diferentes revistas y revisiones de la literatura, tomados de bases de datos como MEDLlNE, EMBASE y PubMed.

Condylar hyperplasia is a condition that affects not only the proportions and facial symmetry in patients, but also static and dynamic occlusion functions with repercussions in the masticatory activity, the health of the temporomandibular joint (TMJ), and the anatomy and volume of adjacent soft tissues. Therefore, according to its severity this disease concerns maxillofacial surgeons, orthodontists, physical therapists, plastic surgeons, and nuclear doctors, who are all closely involved in the diagnosis stage. Historically, diagnosis of condylar hyperplasia has been based on anamnesis and the initial physical examination of the patient, where asymmetry, malocclusion and in some cases temporomandibular disorders (TMDs) are detected and later confirmed with tests such as bone scan and eventually by pathology report once condylar surgery has been done. The purpose of this literature review is to provide detailed information on the behavior of this disease from the point of view of its etiology, clinical characteristics, and distribution by age, sex and affected condyle, as well as the necessary diagnostic and imaging aids for its diagnosis, differential diagnosis, associated diseases, histological characteristics of the affected tissues, and the different therapeutic approaches according to severity, patient's age, and active or inactive form of the condition. The information was obtained from scientific research articles in different journals and literature reviews, taken from databases such as MEDLINE, EMBASE, and PubMed.

Mandibular condyle repair after partial condylectomy in patients with active condylar hyperplasia / Reparación de cóndilos mandibulares después de condilectomía parcial por hiperplasia condilar activa

The different aspects of unilateral condylar hyperplasia have been studied and continue to be controversial; nevertheless, treatment based on condylectomy has been established as part of the working protocol. The aim of this investigation was to identify the bone repair observed in surgically treated condyles after 1 year using cone beam computed tomography (CBCT). Nine subjects were included in this study (6 female and 3 male) with an average age of 18.5 years. They had been diagnosed with active unilateral condylar hyperplasia using SPECT, clinical follow-up of progressive facial asymmetry and CBCT. Patients underwent exclusive condylectomy surgery with a piezoelectric system without disc replacement, orthognatic surgery or any other type of adjunct surgical procedure. Later, they were treated orthodontically for dental compensation or as preparation for orthognatic surgery. A CBCT was performed in the first postoperative month and after 1 year from the surgery to analyze variables. The CBCT at 1 month showed a clear and distinct slice of the condyle without defects or irregularities; the distance from the condylar remnant to the articular fossa reached 8.5 mm in the most extreme case. After 1 year, condylar bone remodeling was observed, with areas of lateral and superior curvature and characteristics of normal condyles, with cortical bone present and a maximum distance of 4.5 mm from the condylar fossa. In conclusion, condylar repair and remodeling can be obtained in these types of surgeries and the morphology of resected condyles after 1 year is quite close to normal macroscopic anatomy.

La hiperplasia condilar unilateral ha sido estudiada en diferentes aspectos y continua siendo controversial; aun así, el tratamiento en base a condilectomía se establece como parte del protocolo de trabajo. El objetivo de esta investigación es reconocer la reparación ósea observada en cóndilos operados después de 1 año mediante tomografía computadorizada cone beam (TCCB). Nueve sujetos fueron incluidos en este estudio (6 sexo femenino y 3 sexo masculino) con una edad promedio de 18,5 años; en ellos se realizó el diagnóstico de hiperplasia condilar unilateral activa mediante estudio de SPECT, seguimiento clínico de la asimetría facial progresiva y TCCB. Se realizó la cirugía de condilectomía exclusiva con sistema piezoeléctrico sin reposición de disco, cirugía ortognática u otro tipo de procedimiento quirúrgico adjunto; posteriormente, los pacientes fueron tratados ortodoncicamente para compensación dentaria o para preparación previa a cirugía ortognática. Se realizó TCCB dentro del primer mes postquirúrgico y después de 1 año de realizada la cirugía para análisis de variables. Se observó en la TCCB de 1 mes un corte nítido y neto del cóndilo, sin defectos o irregularidades; la distancia desde el remanente condilar hasta la fosa articular llegó hasta 8,5 mm en el caso máximo. Después de 1 año, se observo remodelación ósea condilar, con áreas de curvatura lateral y superior características de cóndilos normales, con presencia de hueso cortical y con una distancia máxima de 4,5 mm desde la fosa condilar. Se puede concluir que la reparación y remodelación condilar es viable de obtenerse en este tipo de cirugías y que la morfología de cóndilos resecados después de 1 año es bastante próxima de la anatomía macroscópica normal.

Hiperplasia de cóndilo mandibular: reporte de doce casos / Hyperplasia of the mandibular condyle: considerations in a series of 12 patients

Introducción: La hiperplasia condilar (HC) se define como un crecimiento patológico no neoplásico que afecta tanto al tamaño como a la morfología del cóndilo mandibular. Objetivo: Evaluar la eficacia y riesgos del tratamiento quirúrgico de la HC. Material y método: Estudio descriptivo, serie de casos. Se incluyó a todos los pacientes con diagnóstico de HC tratados en el Hospital Clínico de la Pontificia Universidad Católica de Chile entre enero de 2010 y febrero de 2014. Resultados: Doce pacientes fueron operados en nuestra institución por HC. El promedio de edad fue 19,3 ± 3,4 años. La forma de presentación más frecuente fue presencia de asimetría facial. Todos los pacientes fueron estudiados con SPECT que evidenció diferencia de captación mayor a 50% ± 3,1% entre ambos cóndilos. Todos los pacientes fueron tratados con condilectomía mandibular alta del lado afectado y en 3 casos, se realizó además cirugía ortognática en el mismo tiempo para corrección de maloclusión dental. La mediana de seguimiento fue de meses 16 (5 a 54 meses). En todos los pacientes se evidenció una mejora en la oclusión dental y simetría facial, con desaparición de la disfunción articular previa. Conclusiones: La HC es una entidad de poca frecuencia. La cirugía es eficaz y segura para el tratamiento de la HC.

Introduction: Condylar hiperplasia is defined as a pathological non neoplastic growth which compromises both size and shape of the mandibular condyle and is characterized by progressive facial asymmetry. Aim: To evaluate the efficacy and risks of surgical treatment of HC. Material and method: Descriptive study, cohort of cases. All patients between 2010 and February 2014 with diagnosis of condylar hyperplasia at Hospital Clínico P. Universidad Católica de Chile were included. Results: Twelve patients were operated at our institution because of condylar hyperplasia. Age average was 19.3 ± 3.4 years. The most frequent presentation was facial asymmetry. All patients were studied with single photon emission computed tomography (SPECT) with differential intake more than 50 ± 3.1% between both condyles. All patients were treated with mandibular condylectomy of the affected site and in 3 cases orthognatic surgery was performed at the same time of the condylectomy to correct dental malocclusion. Average follow up was 16 months (5 to 54 months). All patients recovered facial symmetry and occlusion with absence of the previous joint dysfunction. Conclusions: Condylar hyperplasia is an unfrequent condition and surgery is efficient and safe for the treatment of the deformity.

Condylar hyperplasia: An updated review of the literature / 대한치과교정학회지

Condylar hyperplasia (CH) is a rare disorder characterized by excessive bone growth that almost always presents unilaterally, resulting in facial asymmetry. Classification of the different types of CH can differ depending on the authors. Correct diagnosis is critical in determining the proper treatments and timing. This paper is a review of the recent literature on the epidemiology, etiology, diagnosis, classification, and surgical treatments of CH.

Analysis of the condyle, articular fossa and mandibular ramus in subjects with active condylar hyperplasia / Análisis del cóndilo, fosa articular y rama mandibular de sujetos con hiperplasia condilar activa

Facial asymmetry is relatively common, but it becomes a disease when condylar hyperplasia is involved. The purpose of this investigation was to describe and compare the morphological characteristics of hyperplastic condyles to their non-hyperplastic contralateral side. Fifteen subjects aged between 14 and 29 years with facial asymmetry and diagnosed with unilateral condylar hyperplasia were studied using cone-beam computerized tomography. Linear measurements were taken of the condylar morphology on the sagittal and coronal planes, establishing the size of the articular fossa, mandibular ramus, and other aspects. Sagittal condylar measurements showed significant differences (p=0.028) between the groups (hyperplastic side v/s non-hyperplastic side); ramus measurements showed significant differences (p=0.034) between the two sides. No significant differences were observed (p=0.155) in the relation of the mean lateral distance (coronal image) of hyperplastic and non-hyperplastic condyles. It can be concluded that there is an increase in the size of the hemimandible and TMJ on the hyperplastic side, although research with a greater number of patients is needed to establish a more precise trend.

La asimetría facial es relativamente común, transformándose en enfermedad cuando se asocia hiperplásia condilar. El objetivo de esta investigación fue describir y comparar las características morfológicas de los cóndilos hiperplásico con su contralateral no hiperplásico. Quince sujetos de entre 14 y 29 años de edad, con asimetría facial e hiperplasia condilar unliateral diagnosticada, fueron estudiados mediante tomografía computarizada Cone-Beam. Se determinaron mediciones lineales de la morfología condilar en vista coronal y sagital, estableciendo tamaños de la fosa articular, rama mandibular, entre otras. Las mediciones condilares sagitales mostraron diferencias significativas (p=0,028) entre los grupos (lado hiperplásico vs. lado no hiperplásico); las mediciones de longitud de rama mostraron diferencias significativas (p=0,034) entre ambos lados. No se observó diferencias significativas (p=0,155) en la relación de distancia medio lateral (imagen coronal) de cóndilos hiperplásico y no hiperplásicos. Concluimos que existe un aumento del tamaño hemimandibular y de la ATM del lado hiperplásico, aunque investigaciones con mayor número de pacientes son necesarios para establecer una tendencia mas exacta.

Two-Stage Treatment of Facial Asymmetry Caused by Unilateral Condylar Hyperplasia

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.

Condylar Hyperplasia with Long-standing Temporomandibular Joint Dislocation

Deformidad facial asimétrica: papel de la hiperplasia condilar / Asymmetric facial deformity: role of condylar hyperplasia

Las deformidades dentofaciales (DDF) son conocidas y su diagnostico es cada vez mas frecuente; las DDF asimétricas son un grupo de enfermedades de complejo manejo debido a las condicionantes estéticas y funcionales comprometidas. La etiología es variada, aunque la hiperplasia condilar suele estar asociada en los pacientes adolescentes y adultos; su diagnostico se establece mediante análisis facial, estudio con medicina nuclear, tomografías computadorizadas y otros exámenes. La terapéutica mas aceptada hoy día consiste en la condilectomia parcial y la corrección de la deformidad facial basada en las necesidades estéticas y funcionales del paciente. El objetivo de esta revisión es determinar las condicionantes actuales asociadas al diagnostico y tratamiento de las DDF asimétricas y el papel que cumple la hiperplasia condilar en el desarrollo de estas alteraciones faciales...

Dentofacial deformities (DDF) are know and the diagnosis is ever more executed; the asymmetric DDF are a group of disease with difficult management because of esthetic a functional conditions. The etiology is these conditions is varied, although the condylar hyperplasia is frequently in adolescent and adult patients; the diagnosis is realized by facial analysis, nuclear medicine study and computed tomography and others. The more accepted therapy is related to partial condilectomy and facial deformity correction in relation to aesthetic and functional needs of patient. The aim of this review is to determine the current conditions associated to diagnosis and treatment of asymmetric DDF and the role of condylar hyperplasia in the development of these facial alterations...

Hiperplasia condilar: considerações sobre o tratamento e relato de caso / Condylar hyperplasia: treatment considerations and report of a case

A Hiperplasia do Côndilo Mandibular (HCM) corresponde a uma má-formação de desenvolvimento, caracterizada por um crescimento condilar excessivo e autolimitado, resultando em assimetria facial e distúrbios oclusais. A etiologia desta condição ainda não foi totalmente esclarecida, apesar de fatores, como traumatismo prévio, distúrbios hormonais e doenças articulares, terem sido apontados como possíveis causas. Existem diversas classificações para a HCM e, a depender da modalidade de apresentação, poderemos ter diferentes formas de tratamento. Diante de tantos tratamentos possíveis, eleger o modelo mais adequado pode ser um desafio. O objetivo deste trabalho é o de apresentar o caso de um jovem de 14 anos, portador de HCM em atividade, tratado precocemente pela condilectomia alta sem a necessidade de cirurgia ortognática adicional.

Mandibular condylar hyperplasia is a malformation of development of development, characterized by an excessive and self-limitating condylar growth, resulting in occlusal disturbances and facial asymmetry. The etiology of this condition has not yet been fully clarified despite the fact that factors like previous trauma, hormonal disturbances and joint diseases have been indicated as possible causes. There are many classifications of the condition and different forms of treatment are possible depending on the type of presentation. In view of this, choosing the most appropriate form of treatment may represent a challenge. The purpose of this paper is to present the case of a fourteen-year-old boy with an active mandibular condylar hyperplasia treated previously by a high condylectomy without the need for any further ortognatic surgery.

Hiperatividade condilar: diagnóstico e tratamento - relatos de casos / Condylar hyperactivity: diagnosis and treatment - case reports

INTRODUÇÃO: a hiperatividade condilar é uma condição causada por um desequilíbrio nos fatores de crescimento ósseo, gerando assimetrias faciais. Pode ser classificada em três tipos diferentes: hiperplasia hemimandibular (HH), alongamento hemimandibular (AH) e uma forma híbrida. O diagnóstico correto dessas hiperatividades é imprescindível, pois a abordagem é diferente para cada tipo de anomalia, tendo como opções o tratamento ortocirúrgico e a condilectomia alta. OBJETIVO: o objetivo desse artigo é, por meio de dois casos clínicos de assimetria facial causada por hiperatividade condilar, mostrar a importância de um correto diagnóstico e os meios utilizados para a obtenção do mesmo, visando um tratamento adequado para cada caso.

INTRODUCTION: Condylar hyperactivity is a condition triggered by an imbalance in bone growth factors, which causes facial asymmetry. It can be classified into three different types: hemimandibular hyperplasia (HH), hemimandibular elongation (HE) and a hybrid form. It is essential that a correct diagnosis of these hyperactivities be reached since each type of anomaly requires a different approach. Treatment options include surgery and high condylectomy. OBJECTIVES: The purpose of this article is to present two cases of facial asymmetry caused by condylar hyperactivity, showing the importance of an accurate diagnosis and the means used to achieve it while seeking an appropriate treatment for each case.