J Korean Assoc Oral Maxillofac Surg.  2024 Aug;50(4):227-234. 10.5125/jkaoms.2024.50.4.227.

Surgery-early approach combined with condylectomy for correction of severe facial asymmetry with mandibular condylar hyperplasia: a case report

• Suzuki H
• Nogami S
• Otake Y
• Takeda Y
• Sugawara J
• Takahashi T
• Yamauchi K

• KMID: 2559270
• DOI: http://doi.org/10.5125/jkaoms.2024.50.4.227

Abstract

In patients with unilateral mandibular condyle hyperplasia, whether to perform condylectomy and orthognathic surgical procedures at the same time or orthognathic surgery in two stages for remains controversial. Reported here is a case of facial asymmetry with mandibular condyle hyperplasia, for which condylectomy and orthognathic surgery procedures were performed at the same time. A 28-year-old woman was presented to our department with chief complaints of left deviation of the mandible and right temporomandibular joint (TMJ) noise. Findings obtained in several imaging examinations led to a diagnosis of facial asymmetry associated with right mandibular condyle hyperplasia. Following 3 months of preoperative orthodontic treatment, in October 2018 under general anesthesia the patient underwent a right mandibular condylectomy, Le Fort I osteotomy, right mandibular sagittal split ramus osteotomy, and left mandibular inverted L ramus osteotomy. In examinations up to 3 years after surgery, good results were noted. For this case of severe facial asymmetry with mandibular condyle hyperplasia, early surgery and condylectomy were performed simultaneously to significantly shorten the total treatment time. The effectiveness of a surgery-early approach was confirmed by no postoperative findings indicating abnormalities in the TMJ or retroversion.

Keyword

Orthodontic treatment; Facial asymmetry; Orthognathic surgery

Figure

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  Fig. 1 A, B. Facial photographs at initial examination. C. Oral photographs at initial examination.

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  Fig. 2 A, B. Cephalometric radiographs. C. Panoramic radiograph image. D. Cephalometric template analysis. (CDS: craniofacial drawing standards, Ave: average)

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  Fig. 3 A. Bonding brackets on lower dentition and presurgical orthodontic treatment begun. B. Leveling of lower dentition completed. C. Bite plane for temporary bite raising placed and passive rectangular wire engaged in lower arch. D. Surgical wires engaged in upper and lower dentition.

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  Fig. 4 Initial examination, computed tomography images.

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  Fig. 5 Initial examination, magnetic resonance imaging.

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  Fig. 6 Intraoperative photographs. A. The joint capsule was exposed by a preauricular incision to perform condylectomy. B. Resected mandibular head lesion. C. The osteotomy design was step-type and subspinal, and the procedure was performed using a reciprocating saw. The surgeon then moved the osteotomes toward the lateral nasal wall and pterygomaxillary junction to obtain the final maxillary down-fracture. The maxilla was then stabilized utilizing a titanium miniplate. A medial osteotomy cut was made at the level of the lingula and parallel with the occlusal plane using a fissure burr with consecutive cuts performed medial to the external oblique ridge. A buccal cut was performed vertically from the distal portion of the second molar to the inferior border of the mandible. Fragments were separated using a thin osteotome and forceps. After confirmation of a complete mandibular split, an acrylic occlusal splint was used to position the distal segment. The fragments were then stabilized utilizing a titanium miniplate.

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  Fig. 7 Three-dimensional simulation images. A. Right side. B. Frontal. C. Left side.

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  Fig. 8 A. Leveling of upper dentition begun, 24 days after orthognathic surgery. B. Leveling of upper dentition continued, 1.7 months after orthognathic surgery. C. Class II elastics were used for correction of Class II denture, 2.7 months after orthognathic surgery. D. Class II elastics continued, 3.8 months after orthognathic surgery. E. Closing space of upper dentition, 5.1 months after orthognathic surgery. F. Detailing and finishing, 6.8 months after orthognathic surgery.

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  Fig. 9 A-C. Facial and oral images at time of debonding. D-F. Facial and oral images at 1-year follow-up examination.

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  Fig. 10 A-C. Images from 1-year follow-up examination. A, B. Cephalometric radiographs. C. Panoramic radiograph. D, E. Images from 3-year follow-up examination. D. Computed tomography. E. Magnetic resonance imaging.

Reference

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