Three-dimensional skeletal changes after early proportional condylectomy for condylar hyperplasia

Publication date: Available online 10 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R. Fariña, E. Moreno, J. Lolas, F. Silva, B. Martínez

Abstract

The purpose of this study was to evaluate volumetric and dentoskeletal changes in 21 patients with active unilateral condylar hyperplasia (AUCH) after proportional condylectomy. A split-mouth design was used: control group healthy joints (HS, healthy side) and test group affected joints (AS, affected side) (21 per group). Cone beam tomography scans were obtained at T0 (preoperative), T1 (10 days after the intervention), and T2 (approximately 12 months post-surgery). The condylar unit volume (CUV), articular cavity volume (ACV), and dentoalveolar units (DAUs) were measured. CUV showed a difference of 1.12 cm³ between T0 and T1, increasing 0.4 cm³ between T1 and T2 on AS. There was no difference between T0 and T2 on HS. ACV increased 0.65 cm³ between T0 and T1 on AS, after which it decreased by 0.36 cm³ at T2 (0.30 cm³ larger than the initial articular cavity at T0). ACV showed no post-surgery differences on HS. Midline DAU showed extrusion of 0.20 mm for maxilla and 0.52 mm for mandible, while in the lateral area, maxilla was extruded by 0.3 mm on HS and was intruded 0.12 mm on AS. For the mandible, both sides showed extrusion (0.4–0.6 mm). In the distal to canine and molar areas, intrusion of 0.2 mm and 0.9 mm, respectively, was observed on AS; there was extrusion of 0.6 mm distal to the canine on HS. At the mandibular level, AS distal to the canine showed extrusion of 1 mm, while intrusion of 0.2 mm was observed in the molars. For HS, only extrusion at the molar level (0.2 mm) was observed. In conclusion, after proportional condylectomy, a neocondyle forms within 12 months to equal the healthy contralateral side. The articular cavity, which is reduced in the initial stage, increases in size after surgery and the volume gradually approaches that of the healthy side. Dentoalveolar changes occur at the anterior and posterior levels, causing intrusion and extrusion of the interdental crests. An early proportional condylectomy as the sole surgical treatment for patients with AUCH allows normalization of the maxillomandibular relationship.

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