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Condylar Hyperplasia

Done by : Weam Mahmoud faroun


University number: 214102948
Submitted to : DR.Kareem Abu Libdeh

Done By : Weam Mahmoud


Condylar
Mechanical
disorders
Hyperplasia
Chronic Degenerative
polyarthritis joint disease
acquired congenital

TMJ
TMJ disease
TMJ trauma
infection classified

TMJ tumors
TMJ
Extra-articular
abnormalities
connective tissue
Done Bydiseases.
: Weam Mahmoud
Condylar Hyperplasia

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

Done By : Weam Mahmoud


Condylar Hyperplasia

Excessive growth of the mandible

May affect

only condyle whole


condyle. and ramus mandible

Done By : Weam Mahmoud


potential risk factors.

Trauma
hormones
environmental
genetics influences

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

D/D :osteochondroma

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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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


Classification

1 2
Obwegeser and Makek Wolford et al.2

they considered more


based on the inclusive of pathologies
asymmetry and causing CH
predominant growth
vector 4 groups  specific ttt
based on dx
Done By : Weam Mahmoud
Done By : Weam Mahmoud
Done By : Weam Mahmoud
Classification
(Obwegeser and
Makek)

hemimandibular hemimandibular Combination of


hyperplasia elongation both

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hemimandibular elongation
clinical features

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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


• 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

Done By : Weam Mahmoud


Done By : Weam Mahmoud
Hemimandibular
hyperplasia

• 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.

Done By : Weam Mahmoud


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

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hemimandibular
hyperplasia
clinical features

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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


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

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• 5.Associated TMJ pain symptoms may be
present

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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

Done By : Weam Mahmoud


2

1
Done By : Weam Mahmoud
3D CT scan

• 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

Done By : Weam Mahmoud


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

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Associated
Problems

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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.

Done By : Weam Mahmoud


Diagnosis

• Correct diagnosis of CH is essential


when deciding how to treat the
condition
• To prevent post-surgical reversion

Done By : Weam Mahmoud


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.
Done By : Weam Mahmoud
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)

Done By : Weam Mahmoud


• 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.

Done By : Weam Mahmoud


• 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.

Done By : Weam Mahmoud


• 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.

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


Scintigraphy showing activity in the
left condyle.

Done By : Weam Mahmoud


Done By : Weam Mahmoud
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
Done By : Weam Mahmoud
Done By : Weam Mahmoud
Treatment
• 1. the clinical presentation
• 2. whether the condition is active or

Depends on quiescent.. If the condition is quiescent


the patient can be treated as an end stage
deformity with conventional orthodontics
and orthognathic surgery.

• 1.to eliminate the pathologic process

Goals of • to provide optimal functional and


esthetic outcomes.

treatment

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


Done By : Weam Mahmoud
• 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

Done By : Weam Mahmoud


• 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

Done By : Weam Mahmoud


• . 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;

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


Done By : Weam Mahmoud
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.

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


Done By : Weam Mahmoud
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
Done By : Weam Mahmoud
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.

Done By : Weam Mahmoud


• 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

Done By : Weam Mahmoud


• 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

Done By : Weam Mahmoud


• 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

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


• 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.

Done By : Weam Mahmoud


• 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.

Done By : Weam Mahmoud


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

Done By : Weam Mahmoud


Done By : Weam Mahmoud

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