Conylar hyperplasia

Condylar Hyperplasia
Done by : Weam Mahmoud faroun
University number: 214102948
Submitted to : DR.Kareem Abu Libdeh
Done By : Weam Mahmoud

TMJ disease
classified
Degenerative
joint disease
TMJ trauma
Mechanical
disorders
Chronic
polyarthritis
TMJ
infection
TMJ tumors
Extra-articular
connective tissue
diseases.
TMJ
abnormalities
congenitalacquired
Condylar
Hyperplasia

• Other names
• hemimandibular hypertrophy
• temporomandibular joint (TMJ) condylar
hyperplasia
• hypercondylia

Excessive growth of the mandible
only
condyle.
May affect
condyle
and ramus
whole
mandible

potential risk factors.
Trauma
hormones
environmental
genetics influences

excessive growth usually ceases when normal growth
has ended.
However, cases recurrence of growth takes place
after cessation of normal growth.
D/D :osteochondroma

Typical mandibular condyle soft tissue histology
includes four layers:
1. fibrous articular layer
2. undifferentiated mesenchymal layer
3. transitional layer
4. hypertrophic cartilage layer.
Active CH has been found to display a broader
mesenchymal layer than that in the normal condyle.7

Gene
test
IGF-1 and IGF-1
receptor (IGF-
1R) expression
was found to
significantly
increase in
chondrocytes
affected by CH

Classification
1
Obwegeser and Makek
based on the
asymmetry and
predominant growth
vector
2
Wolford et al.2
they considered more
inclusive of pathologies
causing CH
4 groups  specific ttt
based on dx

Classification
(Obwegeser and
Makek)
hemimandibular
hyperplasia
hemimandibular
elongation
Combination of
both

hemimandibular elongation
clinical features

1. Horizontal displacement of the mandible and
chin toward the unaffected side.

2. Usually there is a mild protrusion and lip line
slopes down, toward the affected side

3.On the unaffected side there may be a lateral
cross bite.. midline deviates to the unaffected
side

• 4. The occlusal plane sometimes slopes
upward to the unaffected side.

5. Secondary over eruption of the maxillary
teeth on the affected side to maintain the
functional occlusion.

• In the radiographs PA view elongation of the
neck of the condyle with increased normal
height on the affected side will be seen.
Condylar head also may show enlargement

• characterized by a three-dimensional
enlargement of one side of the mandible,
thus, there is enlargement of the condyle, the
condylar neck and the ascending ramus and
the body.
Hemimandibular
hyperplasia

The abnormal growth terminatesprecisely at the
symphysis, giving rise to a sharp ‘step’

hemimandibular
hyperplasia
clinical features

• 1.One side of the face appears to be enlarged.

2.Unilateral ‘bowing’ of the inferior border of
themandible is seen on the affected side.

• 3.The lip line slopes downward on the affected
side.

• 4.Gross occlusal discrepancies like lateral
open bite on the affected side, and increased
vertical maxillary height on the affected side
may be seen.

• 5.Associated TMJ pain symptoms may be
present

Radiographically
1. the entire hemimandible on the affected side is
enlarged and the inferior dental canal is
displaced toward the lower border.
2. The elongation of ascending ramus (unilateral).
3. Elongation and thickening of the condylar
neck(unilateral).
4. An irregular and deforming enlargement of the
condyle (unilateral).
5. The OPG demonstrates a pathognomonic
appearance

• 1. Asymmetry of the lower jaw,
• 2.unilateral rounding off of the angle and
typical bowing of the inferior border of the
mandible.
• 3. Increased height of the body of the
mandible is also seen unilaterally
3D CT scan

2.unilateral rounding off of the angle
and typical bowing of the inferior
border of the mandible.
• . Asymmetry of the lower jaw
3. Increased height of the body of the
mandible is also seen unilaterally

Associated
Problems

1.Esthetic problems
2.Functional problems
3.Psychological problems (Tarnishing self-image)
4.Impairment of mastication
5.Impact on digestion—general health
6.Associated speech problems
7.Difficulty in maintaining oral hygiene
8.Susceptibility to caries and periodontal problems
9.Possible TM joint pain dysfunction.

Diagnosis
• Correct diagnosis of CH is essential
when deciding how to treat the
condition
• To prevent post-surgical reversion

Diagnostic methods
clinical examination
Radiographs and cephalometry
nuclear imaging can be used to determine
the type of CH as well as its activity.
three-dimensional tomography
and PET scans.

Nuclear imaging
• is capable of providing physiological details of CH
using radionuclide-labeled tracers
• Planar scintigraphy produces a two-dimensional
image, as opposed to SPECT and PET, which
produce three-dimensional images.
• Bone scintigraphy has high sensitivity and low
specificity for bone metabolism, meaning that it
can identify when a change in bone metabolism is
present but is limited in its ability to differentiate
among various conditions (e.g., bone healing,
growth, infection, arthritic changes, or tumors)

• One of the first steps in managing CH cases is
to determine if the mandible is actively
growing. This determination can be made with
many methods, but bone SPECT is an essential
diagnostic tool to assess active growth.

• In this quantitative method, 99mTc-MDP is
injected and absorbed into hydroxyapatite
crystals and calcium in the bone. The bone is
then scanned using the SPECT technique, and
the hyperplastic condyle is quantitatively
compared to the contralateral side.

• Often only a 0-5% difference in positive area
is observed between normal condyles.
Differences greater than 10% between two
condyles are considered to indicate active
growth due to CH.
• Therefore, a relative 55% uptake in the
affected hyperplastic condyle is considered to
be abnormal.

• During active growth phase of
hemimandibular elongation and
hemimandibular hyperplasia, scintigraphy
carried out demonstrates increased uptake in
the condyle of the affected side.

Scintigraphy showing activity in the
left condyle.

Histopathological examination
• 1.revealed thickened irregular bony
trabeculae
• 2. uninterrupted layer of undifferentiated
mesenchymal cells
• 3. hypertrophic cartilage
• 4. islands of chondrocytes in subchondral
trabecular bone
• 5. increased thickness of cartilaginous layer

Treatment
• 1. the clinical presentation
• 2. whether the condition is active or
quiescent.. If the condition is quiescent
the patient can be treated as an end stage
deformity with conventional orthodontics
and orthognathic surgery.
Depends on
• 1.to eliminate the pathologic process
• to provide optimal functional and
esthetic outcomes.Goals of
treatment

• Typically, are not needed
in these cases.
• However, if the
condition is active, a
decision can be made to
observe until condylar
growth has stopped or
perform a growth
arresting procedure (high
condylectomy) combined
with orthognathic
surgery if needed.
TMJ
procedures

condylectomy
• High for active CH offers highly predictable and stable
outcome.
• If carried out early in the process, secondary dental
and maxillary compensations may be avoided.
• High condylectomy can be performed through a
preauricular approach or a submandibular endoscopic
technique
• The hyperplastic portion of the condyle is visually
identified (approximately the superior 4–5 mm of the
condyle) and is resected, and the apparent normal
condyle is left in place

• A new technique has been described by
Bouchard and colleagues, using a g-probe
intraoperatively and having the patient
injected with technetium 2 hours
preoperatively.
• This technique allows an objective guide for
removal of the correct amount of bone

• CH treatment options are detailed from the
simplest, least invasive to most complex
procedures.
• 1. mandibular ramus osteotomy of affected
condyles..
• 2. condylectomies
• 3. condylectomy and orthognathic surgery

• . One of the simplest procedures that can be
performed is a mandibular ramus osteotomy
of affected condyles..
• patients with unilateral CH can effectively be
treated with unilateral ramus osteotomies on
the affected side. Bilateral osteotomies did
not show any advantages over unilateral
procedures;

1. mandibular ramus osteotomy of affected condyles..
• they may be indicated for patients with
severely prognathic profiles and patients in
whom unilateral osteotomies could possibly
lead to excessive rotation of the unaffected
condyle.
• Combining the osteotomies with Le Fort I is
effective in restoring occlusal discrepancies

condylectomy
• condylectomy was an appropriate treatment
for unilateral CH. 4-5 mm was removed from
the upper pole of the affected condyle, which
appeared to effectively limit growth in CH.

condylectomy and orthognathic
surgery.
• this treatment was found to be very effective
for correcting both functional and esthetic
problems resulting from CH.

TMJ function after the condylectomy
• Limited studies report postoperative function in
patients who have undergone a condylectomy.
• From the functional point of view, the mandibular
dynamic is maintained with no significant
changes when the high condylectomy is
performed
• patients undergoing condylectomy for CH
presented no differences in disc displacement or
myofacial pain when compared to patients
without CH

Refrences
• Nolte JW, Schreurs R, Karssemakers LHE,
Tuinzing DB, Becking AG, Demographic
features in Unilateral Condylar Hyperplasia:
an overview of 309 asymmetric cases and
presentation of an algorithm, Journal of
Cranio-Maxillofacial Surgery (2018), doi:
10.1016/ j.jcms.2018.06.007.

• Chouinard, A.-F., Kaban, L. B., & Peacock, Z. S.
(2018). Acquired Abnormalities of the
Temporomandibular Joint. Oral and
Maxillofacial Surgery Clinics of North America,
30(1), 83–96. doi:10.1016/j.coms.2017.08.005

• Sergio Olate1,2, Henrique Duque Netto3 ,
Jaime Rodriguez-Chessa4 , Juan Pablo Alister1
, Jose de Albergaria-Barbosa5 , Márcio de
Moraes5 , (2013) Review Article Mandible
condylar hyperplasia: a review of diagnosis
and treatment protocol /ISSN:1940-
5901/IJCEM1308017

• XAVIER, Samuel Porfírio et al. Two-Stage
Treatment of Facial Asymmetry Caused by
Unilateral Condylar Hyperplasia. Braz. Dent.
J. [online]. 2014, vol.25, n.3

• Luis Eduardo Almeida, Joseph
Zacharias, and Sean Pierce (2015), Condylar
hyperplasia: An updated review of the
literature, Korean J Orthod ,PMC4664909

• Mehrotra D, Dhasmana S, Kamboj M, Gambhir
G. Condylar Hyperplasia and Facial
Asymmetry: Report of Five Cases. Journal of
Maxillofacial & Oral Surgery. 2011;10(1):50-
56. doi:10.1007/s12663-010-0141-5.

• Mouallem G, Vernex-Boukerma Z, Longis J,
Perrin J-P, Delaire J, Mercier J-M, Corre P,
Efficacy of proportional condylectomy in a
treatment protocol for unilateral condylar
hyperplasia: A review of 73 cases, Journal of
Cranio-Maxillofacial Surgery (2017), doi:
10.1016/ j.jcms.2017.04.007.

• Prof. Dr. Anil Malik,Neelima ,Textbook of Oral
and MaxillofacialSurgery , Second Edition ,
2008, Neelima Anil Malik

Conylar hyperplasia

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