Collaborative treatment for a case of condylar hyperplastic facial asymmetry

Abstract

Facial asymmetry can be caused by unilateral condylar hyperplasia. In such cases, it may be difficult to achieve symmetry since there is dentoalveolar compensation on the affected side, and the occlusal cant does not correspond to the frontal mandibular deviation. In the case presented, surgical orthodontic treatment and orthognathic surgery planning was accomplished for a patient with facial asymmetry due to condylar hyperplasia. The surgical plan was devised with particular attention to the severe dentoalveolar compensation. In this case, prior to the two-jaw surgery, the occlusal cant and frontal mandibular plane inclination was corrected through impaction of the left molar region by segmental osteotomy. Facial asymmetry and severe dentoalveolar compensation were successfully corrected after a unilateral segmental osteotomy and two-jaw surgery, resulting in a stable occlusal relationship and facial symmetry as well as good jaw function. Collaboration between the orthodontists and maxillofacial surgeons was essential for the successful treatment of the patient.

Unilateral condylar hyperplasia treated with simultaneous 2-jaw orthognathic surgery and posterior segmental osteotomy

“…Condylectomy can be considered a priority for cases of CH beyond a moderate level, but there is a risk of temporomandibular dysfunction after surgery. [21][22][23] Therefore, if the patient's condyle is confirmed to be inactive through bone scintigraphy, orthognathic surgery is recommended. 8,9 In addition, adolescents with CH must wait until growth ceases because facial asymmetry may get severe.…”

“…14,26 In this case, this approach was excluded because the lower mandibular border and the mandibular canal of the patient were too close to each other. There are two methods of posterior segmental osteotomy: one performed separately from 2-jaw surgery, 22 and one performed simultaneously with 2-jaw surgery. The disadvantage of the former method is that the patient has to undergo surgery under general anesthesia twice.…”

“…This would be enhanced by additional surgery such as muscle attachment surgery 29 and contouring surgery. 22 Canting-type facial asymmetry resulting from CH was successfully corrected through simultaneous 2jaw orthognathic surgery and posterior segmental osteotomy. After 2 years of retention, the patient had no TMD and maintained a good facial appearance and occlusion.…”

Tratamiento ortodóncico-quirúrgico de pacientes con asimetría facial.

“…26 En el estudio de Usumi R se presenta una paciente con asimetría facial por hiperplasia condilar unilateral que siguió esquema de tratamiento ortodoncia y a los 14 meses cirugía, osteotomía segmentaria mandibular izquierda al no mostrar cambios significativos; a los 26 meses de iniciado el tratamiento se procedió a cirugía de dos mandíbulas: una osteotomía Le Fort I y una osteotomía sagital de la rama dividida, con esto se logró mejora en la asimetría facial, aunque al año postquirúrgico fue necesario recortar 2.0 mm de la protuberancia del hueso cortical de su borde mandibular izquierdo. 27…”

Alternativas diagnósticas y de tratamiento para la corrección de asimetrías faciales: Revisión bibliográfica.

“…La asimetría facial puede ser causada por hiperplasia condilar unilateral. Según la velocidad de desarrollo de este, puede provocar canteamiento oclusal o presencia de mordida abierta posterior, con alteraciones en línea media dental 18 , 23 .…”