What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

Abstract

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.

Relationship between Posterior Permanent Dentition Pattern and Radiographic Changes of the Mandibular Condyle

“…Accordingly, this study aimed to assess the relationship between posterior permanent dentition and radiographic changes of the condyle. This study used panoramic radiographs of patients due to their easier availability and according to studies by Mathew et al [23] and Nelke et al [24].…”

Orthodontic-surgical Management of the Horizontal Unilateral Condylar Hyperplasia

“…1 The extra-and intra-oral clinical features of the malocclusion resulting from UCH are not homogenous for all the patients at first consultation, mainly for the progressive nature of the disease and for the direction of condylar overgrowth (vertical, horizontal or hybrid, which has the clinical characteristics of both), that could determine different clinical and radiographic characteristics. 5 The horizontal pattern is characterized by a complex clinical picture related with the time elapsed from the onset of the hyperplasia, but the constant clinical feature is the "asymmetrical prognathism" with asymmetry of the facial lower third, deviation of chin and mandibular midline toward the healthy side without involvement of the maxillary occlusal plane, that not do not show canting, and class III relationships on the affected side [6][7][8] (Figure 1A-C); the condylar hyperdevelopment could lead to elongation of both ramus and body on the affected side 9 (Table 1).…”

“…Panoramic radiograph is the first instrumental examination able to detect differences between the 2 sides of the lower jaw, with evidence of the hyperplastic condyle associated often with a unilateral lengthening on the transverse plane. 9,11 (Table 1, Figure 2) As the horizontal UCH develops mainly on the transverse plane, the lateral cephalometric radiograph does not show specific features, while the posterior-anterior cephalometry is able to measure the mandibular midline deviation and the position of gonial angles on the coronal plane, with respect to the midline. Patients affected by facial asymmetry present a malocclusion involving the 3 planes of the space, therefore a 3-dimensional assessment performed on Cone Beam Computed Tomography is now preferred to reduce the errors caused by distortion or magnification of the 2-dimensional cephalograms.…”