Osteochondroma in the mandibular condyle that caused facial asymmetry: a case report

Osteochondroma is the most common benign tumor of the axial skeleton, though it is rarely found in the oral and maxillofacial regions. Reported is a case of osteochondroma affecting the mandibular condyle of a 22-year-old Japanese woman. The patient visited the hospital with the chief complaint of facial asymmetry. She had pain with clicking on her right temporomandibular joint (TMJ), resulting in trismus and facial asymmetry with a chin deviation to the left side. Her maximum jaw opening was 34 mm, with moderate left TMJ tenderness. There was Class I occlusion without open bite. Panoramic radiography and computed tomography (CT) revealed an enlarged right mandibular condylar head. Magnetic resonance imaging (MRI) also showed an enlarged condyle with hyperintense bone marrow on a T2-weighted image. Condylectomy and condyloplasty were performed. Surgical specimen of the lesion revealed osteochondroma of the mandibular condyle head. Two months after the initial surgery, facial asymmetry was surgically corrected by Le Fort I osteotomy and chin reduction. The patient was discharged from the hospital with no subjective complaints. At the time of this report, the patient had been followed up for seven months, and there had been no evidence of recurrence.     

计算机辅助下颌骨髁突外生性骨软骨瘤的手术切除

目的:利用计算机辅助设计(computer assisted designing,CAD)指导下颌骨髁突(mandibular condyle)外生性骨软骨瘤(exostosis osteochondroma)的瘤体切除,并评价其应用效果。方法:8例患者采用Surgicase CMF 5.0软件进行瘤体切除的术前设计。术后将CT数据与术前设计进行融合,并利用SAS8.0软件包对手术前、后髁突形态测量值进行配对t检验,评价手术效果。结果:8例患者瘤体均完整切除,术后髁突形态与术前设计吻合度高,平均误差为(1.82±1.25)mm。结论:计算机辅助设计可于术前合理选择截骨线部位,有助于肿瘤的完整切除及患侧正常部分髁突的保存。     

Accuracy of implant placement with a stereolithographic surgical guide

PURPOSE: Placement of dental implants requires precise planning that accounts for anatomic limitations and restorative goals. Diagnosis can be made with the assistance of computerized tomographic (CT) scanning, but transfer of planning to the surgical field is limited. Recently, novel CAD/CAM techniques such as stereolithographic rapid prototyping have been developed to build surgical guides in an attempt to improve precision of implant placement. However, comparison of these advanced techniques to traditional surgical guides has not been performed. The goal of this study was to compare the accuracy of a conventional surgical guide to that of a stereolithographic surgical guide. MATERIALS AND METHODS: CT scanning of epoxy edentulous mandibles was performed using a cone beam CT scanner with high isotropic spatial resolution, while planning for 5 implants on each side of the jaw was performed using a commercially available software package. Five surgeons performed osteotomies on a jaw identical to the initial model; on the right side a conventional surgical guide (control side) was used, and on the left side a stereolithographic guide was used (test side). Each jaw was then CT scanned, and a registration method was applied to match it to the initial planning. Measurements included distances between planned implants and actual osteotomies. RESULTS: The average distance between the planned implant and the actual osteotomy was 1.5 mm at the entrance and 2.1 mm at the apex when the control guide was used. The same measurements were significantly reduced to 0.9 mm and 1.0 mm when the test guide was used. Variations were also reduced with the test guide, within surgeons and between surgeons. DISCUSSION: Surgical guidance for implant placement relieves the clinician from multiple perioperative decisions. Precise implant placement is under investigation using sophisticated guidance methods, including CAD/CAM templates. CONCLUSION: Within the limits of this study, implant placement was improved by using a stereolithographic surgical guide.     

3D打印导板辅助髁突骨软骨瘤及继发复杂牙颌面畸形的手术治疗

目的:研究3D打印手术导板辅助髁突骨软骨瘤及继发牙颌面畸形同期矫治的临床可行性。方法:根据影像学资料,运用Dolphin Imaging 11.7 Premium 和Mimics软件进行虚拟外科手术设计并制作3D打印手术导板,指导髁突骨软骨瘤及继发牙颌面畸形的手术矫治。通过对比模拟头颅模型与实际术后CT重建模型评估此方法的临床价值。结果:所有患者患侧关节功能、咬合关系以及颜面对称性都得到了良好的恢复。模拟术后模型与术后扫描重建模型对比中,中切牙与第一磨牙的误差均保持在1.4 mm以下,最大误差出现在颏部,约2.4 mm,显示了新方法的准确性。结论:结果显示虚拟外科手术设计和手术导板有助于髁突骨软骨瘤继发牙颌面畸形的准确诊断、治疗方案设计、准确截骨以及重置骨块。     

Nonsebaceous lymphadenoma of salivary gland: report of a case with immunohistochemistry and review of the literature

BACKGROUND: Osteochondromas (OCs) are rare in the craneofacial area (0.6%). We present 2 cases of OC of the mandibular condyle, emphasizing the surgical decision of each case. CASE 1: In a 48-year-old woman with facial asymmetry, left cross-bite, and mandible deviation to the left, a computerized tomographic (CT) scan confirmed the presence of a bony expansion of the right condyle. The clinical diagnosis was osteochondroma. The patient underwent condylectomy with costochondral reconstruction. CASE 2: In a 76-year-old woman with a 1-month history of right preauricular pain, CT showed a deformed right condyle with a bony mass at the base of the temporal bone and the articular fossa. OC of the skull base was diagnosed, with possibly a concurrent lesion of the condyle. The patient underwent condylectomy with the removal of the skull base mass and an inmediate TMJ reconstruction by means of an appropriately sized stock total TMJ prosthesis. CONCLUSIONS: It is necessary to personalize the temporomandibular joint reconstructive options.     

Mandibular asymmetry treated with a modified activator appliance

Aplasia of the mandibular condyle alone without any other facial malformation and medical history is a very rare condition. This clinical report describes treatment with a functional appliance in a young patient with aplasia of the mandibular condyle alone without any other facial malformation, which is a very rare condition. The patient, a 6(1/2)-year-old girl, was referred for treatment of mandibular asymmetry. There was no relevant family history. The patient showed early mixed dentition with a II molar relationship on the right and II on the left side, 5 mm of overbite and 5 mm of overjet, and a lower midline discrepancy of 3 mm. According to the Pruzansky-Kaban classification of mandibular deformity, the patient was a type IIA; according to Vento and his classification, the mandible of the patient was M2B. The patient was given a Haupl-Andresen activator, which had been modified to reposition the right mandible downward and forward. The functional appliance therapy lasted for approximately 4 years. The affected side showed remarkable condylar growth compared with the normal side. Seven years later, the correction of the mandibular asymmetry was stable and no relapse had occurred.     

Osteoma of mandibular condyle as cause of acute pain and limited-mouth-opening: case report

In benign tumors in the mandibular condyle such as osteoma and osteochondroma, symptoms such as pain and limited-mouth-opening are rarely observed. Therefore, these tumors are often detected after the development of changes in occlusion and mandibular midline deviation. We encountered a very rare patient with mandibular condyle osteoma who showed acute pain and markedly limited-mouth-opening.     

Osteochondroma of the temporomandibular joint: a case report

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.     

Osteochondroma of the mandibular condyle: a case report and review of the literature

Osteochondroma is rarely found in the oral and maxillofacial regions. A rare case of osteochondroma affecting the mandibular condyle of a 46-year-old Japanese woman is reported. Clinical examination revealed facial asymmetry, malocclusion, and a palpable hard mass in the right temporomandibular joint (TMJ). Radiologically, the lesion was visualized as a radiopaque mass in the same region, but no destructive features were evident. Three-dimensional computed tomography was employed for estimating the stereographic extension of the lesion, which seemed to develop from the anterior portion of the condylar neck, and extend to the condylar head. The patient underwent tumor excision and condyloplasty under a clinical diagnosis of benign TMJ tumor. The histopathological diagnosis was osteochondroma of the mandibular condyle, and the lesion consisted of proliferative bony and hyalinized cartilage-like tissues. Moreover, a cartilage cap, a characteristic feature of osteochondroma, was also observed. Thirty-eight cases of osteochondroma of the mandibular condyle described in the English literature, including the present case, were reviewed. The mean patient age was 39.7 years with a peak in the fourth decade, which was older than patients with tumors in the axial skeleton. There was no sexual predominance for tumors in either the mandibular condyle or axial skeleton. The histopathogenesis of this tumor developing in the mandibular condyle was also discussed.     

From ideal occlusion to dentofacial deformity and back to ideal: an osteochondroma treatment with lingual orthodontics

This original case report describes the morphologic changes caused by a mandibular condylar osteochondroma (OC) on a female patient and its treatment. The changes were identified by comparing her final records from a previous orthodontic treatment, without the presence of OC, to records taken before a second treatment, with a developed OC. The diagnostics and treatment for the OC and its consequences were described and discussed in this paper. Treatment included orthodontics with a lingual appliance, low condylectomy on the affected side, high condylectomy on the contralateral side, bilateral disc repositioning and orthognathic surgery. It was concluded that the OC caused a Class III subdivision malocclusion, midline deviation and an edge-to-edge bite on the left side, a cant of the occlusal plane on the Z-axis and a deviation of the pogonion to the left. Treatment was successful and stable long term (36 months) with good occlusal, aesthetical and functional results.     

Correction of Unilateral Condylar Hyperplasia and Posterior Open Bite with Proportional Condylectomy and Fixed Orthodontic Treatment

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

Condylar osteochondroma manifesting as Class III skeletal dysplasia: diagnosis and surgical approach

This is a case report of a 21-year-old man who had a gradually progressive Class III malocclusion and crepitation of the right temporomandibular joint. Routine TMJ tomograms revealed a radiopaque-radiolucent lesion of the right mandibular condyle with a compensatory anteroinferior displacement of the left mandibular condyle. Nuclear bone scans confirmed increased asymmetric technetium 99 tracer uptake in the region of the right temporomandibular joint. A two-stage surgical approach was undertaken; this consisted of excision of the condylar lesion to correct the Class III malocclusion and posterior crossbite and a LeFort I osteotomy to correct the slight transverse maxillary cant and anterior open bite. A histopathologic diagnosis confirmed osteochondroma of the mandibular condyle.     

数字化导板引导髁突巨大骨软骨瘤手术切除1例报告

髁突外生型骨软骨瘤常采用手术切除,但切除范围多基于术者经验,易导致肿瘤复发或神经血管损伤。本文报道髁突巨大外生型骨软骨瘤1例,采用计算机辅助设计技术（Proplan 1.3软件）术前确定瘤体与髁突关节面边界,模拟设计手术入路、截骨平面及瘤体取出路径,并利用快速成型技术制作数字化截骨导板,于术中应用。该数字化导板可精确指导髁突巨大外生型骨软骨瘤切除并保护未受累髁突软骨面,避免神经血管损伤,节约手术时间。     

Mandibular distraction osteogenesis using an intraoral device and bite plate for a case of hemifacial microsomia.

OBJECTIVE: To present orthodontic treatment combined with mandibular distraction osteogenesis using an intraoral device and a bite plate in a patient with hemifacial microsomia, severe facial asymmetry, and unilateral mandibular hypoplasia. PATIENT: An 8-year-old girl exhibited mandibular deviation resulting from hypoplasia of the mandibular condyle and ramus on the left side. The patient was treated with an intraoral device for mandibular distraction osteogenesis, bite plate, and hybrid-type functional appliance. Facial asymmetry was improved, and the mandibular ramus was elongated in an anterior and primarily posterior direction with slightly posterior and superior displacement of the proximal segment. Postdistraction treatment results have been stable for 1 year. At the 1-year follow-up, the volume of the lateral and medial pterygoid muscles on the left side had increased. The condyle and disc on the right temporomandibular joint moved well and in harmony at open mouth position, and a rotational movement of the left temporomandibular joint was observed.     

髁状突骨软骨瘤病1例

目的为偏[牙合]畸形的原因提供一个新的诊断思路。方法报道1例髁状突骨软骨瘤病例,并回顾相关文献。结果1例50岁男性髁状突软骨瘤患者,术前CT检查明确病变部位及大小,全麻下切除病变骨并进行颞下颌关节重建,术后进行颌间牵引,咬合关系恢复良好。结论对状突骨软骨瘤,为避免复发及恶变,须作肿物切除术,如肿物与髁突粘连,须作髁突切除术及颞下颌关节重建,恢复患者的咬合关系。     

A relatively minor adult case becomes significantly complex: A lesson in humility.

A 41-year-old white woman with no particular concerns about facial esthetics was first seen with bilateral Class II molar relationship, a Class I right canine, and a Class II left canine. Overjet was 3 mm and overbite was 0.5 mm, with no incisor contact. A maxillary right premolar was missing for unknown reasons and all 4 third molars had previously been extracted. The maxillary midline was 2 mm to the right of the facial midline, and the mandibular midline was 3.5 mm to the left of the maxillary midline. There was 7 mm of crowding in the maxillary arch and 6 mm of crowding in the mandibular arch, with an increased curve of Spee. The patient had a well-positioned maxilla, a retrognathic mandible with increased convexity, a Class II denture base relationship, and a vertical facial pattern. The treatment plan consisted of extracting the maxillary left first premolar and the mandibular left central incisor. After 4 months of treatment, an open bite from second premolar to second premolar was noted. After 6 months of treatment, the patient expressed concern with her chin position and mentalis hyperactivity. It was apparent that the orthodontic treatment had resulted in molar extrusion, which the musculature was not able to withstand. Treatment continued and the case was set up for posterior maxillary impaction and mandibular advancement surgical procedures.     

Osteochondroma of the mandibular condyle: report of case.

A case of osteochondroma of the mandibular condyle has been presented. The facial and occlusal deformities produced by the tumor are described. After the surgical treatment and concomitant orthodontic treatment, satisfactory occlusion and facial contour were established.     

Osteochondroma of the mandibular condyle. Report of a case and review of the Japanese literature

A case of osteochondroma of the mandibular condyle causing severe facial asymmetry and malocclusion (occlusal deviation) is presented. A 63-year-old woman was successfully treated by removal of the tumor and condylectomy. In addition, 4 cases of osteochondroma of the mandibular condyle reported in the Japanese literature are reviewed with respect to several clinical items.     

计算机辅助设计和制作技术在髁突骨软骨瘤合并颌骨畸形治疗中的应用:附1例报告

目的:探讨计算机辅助设计与制作(computer-aided design/manufacture,CAD/CAM)技术在髁突骨软骨瘤合并颌骨畸形治疗中的应用。方法:髁突骨软骨瘤合并上、下颌骨畸形1例,采用计算机辅助设计技术(SurgiCase CMF 5.0软件进行CT数据处理)模拟切除肿瘤,上、下颌骨截骨,设计虚拟中间和终末板及截骨导板,并进行术后效果预测;应用快速原型(rapid prototyping,RP)技术制作中间板和截骨导板,术中应用。术后进行CT检查,并与术前设计进行比较,评价应用效果。结果:术后CT显示,截骨效果与术前设计吻合度高,术后随访6个月肿瘤无复发,患者面形对称。结论:应用CAD/CAM技术进行髁突肿瘤切除及合并颌骨不对称畸形的辅助治疗,可以提高手术的准确性,节约手术时间,具有一定的应用前景。     

Osteochondroma of the mandibular condyle: literature review and report of a case

AIM: The intent of this report is to present a brief review of the literature on osteochondroma and to present a case involving the surgical removal and replacement of a major portion of the condyle and angle of the mandible using free autogenous mandibular bone. BACKGROUND: While osteochondroma is the most common tumor of skeletal bones, it is relatively uncommon in the jaws occurring at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. REPORT: A case of a 29-year-old woman with an osteochondroma of the mandibular condyle is presented. Surgical treatment was tumor resection, grafting, and reshaping of the mandibular angle and ramus. As this lesion is usually asymptomatic and discovered incidentally on radiographic examination, the general practitioner usually is the first professional to make the diagnosis. SUMMARY: Condylectomy cannot be recommended as routine in all cases.37 Common surgical treatments include condylectomy and reconstruction.24 If the tumor involves only a limited area of the condylar surface, then preservation of the remaining portion of the condyle and reshaping should be done. Reasons for not taking such a conservative approach are the possibilities of malignancy and the risk of recurrence. In this case report the extraoral vertical ramus osteotomy, associated with free autogenous mandibular bone, presented several advantages.