Condilectomía proporcional y precoz: Tratamiento etiológico de la hiperplasia condílea

espanolIntroduccion. La hiperplasia condilea unilateral activa (HCUA) es una enfermedad compleja que causa graves alteraciones en la funcion y estetica facial. Para su tratamiento se han propuesto diferentes protocolos como condilectomia alta, asociada o no a cirugia ortognatica. En este trabajo nos planteamos si una condilectomia proporcional puede resolver por si sola las alteraciones faciales, oclusales y esqueleticas causadas por la hiperplasia condilar de forma tridimensional, y evitar una posible cirugia ortognatica complementaria. Metodo. Se realizaron dos tipos de estudios: a) medir los cambios faciales, oclusales y esqueleticos en pacientes con HCUA, que fueron sometidos unicamente a una condilectomia proporcional, y b) comparar la condilectomia alta con la proporcional en relacion con la necesidad de cirugia ortognatica secundaria. Resultados. En el primer estudio, se incluyeron 16 pacientes: en nueve se obtuvo un centrado total del menton blando; en siete, la nivelacion del plano bicomisural del labio, y dos requirieron cirugia ortognatica diferida. En el segundo estudio se incluyeron 49 pacientes con una edad media de 19,7 ± 3,72 anos. La mayoria de los pacientes eran mujeres (n = 32; 65,3%). De los 38 pacientes sometidos a condilectomia proporcional, solo seis casos (15,8%) requirieron de una cirugia ortognatica secundaria, mientras que de los 11 pacientes sometidos a una condilectomia alta, 10 (90,9%) requirieron cirugia ortognatica secundaria. Conclusion. La condilectomia precoz y proporcional como tratamiento unico y etiologico es una alternativa de tratamiento racional en los casos de HCUA. EnglishIntroduction: Active unilateral condylar hyperplasia (AUCH) is a complex disease that causes severe alterations in the function and facial aesthetics. Many protocol treatments have been proposed such as high condylectomy, with or without orthognathic surgery. In this study we wanted to know if a proportional condylectomy by itself could solve the facial, occlusal, and skeletal alterations caused by condylar hyperplasia and avoid possible complimentary orthognathic surgery. Method: Two kinds of studies were done: (i) measurement of the facial, occlusal and skeletal changes in patients with AUCH, who only had a proportional condylectomy; and (ii) a comparison of high condylectomy with the proportional one to determine if there is a secondary need for orthognathic surgery. Results: 16 patients were included in the first study; in nine of them a perfect center of the chin was achieved, seven leveled the lip’s bicommissural plane, and only two also required orthognathic surgery. The second study included 49 patients, average age 19.7 ± 3.72 years; most of them were women (32, 65.3%). Of the 38 patients who had proportional condylectomy, only six (15,8%) required secondary orthognathic surgery. On the other hand, of the 11 patients who had a high condylectomy, 10 (90.9%) required secondary orthognathic surgery. Conclusion: Early proportional condylectomy as a sole etiological treatment is a rational alternative of treatment in cases of AUCH.