Osteochondroma of mandibular condyle: conservative reconstruction with condylectomy

Mandibular condylar osteochondroma is a unilateral benign pathological condition, with proliferation of osseous and cartilaginous components through the head of the condyle, causing enlargement with extensions that can develop in any direction off of the condyle. It is a progressive pathology often resulting in significant facial deformity, pain, and masticatory and occlusal dysfunction. Traditional treatment options include condylectomy and condylar replacement with rib graft or total joint prosthesis. This investigation evaluated the outcome of a more conservative treatment eliminating the need to harvest a graft or place a prosthetic joint. Methods: The study consisted of 15 patients (11 women and 4 men) with average age of 25.6 years (13 to 44 years) and osteochondroma of either their right condyle (n 6) or left condyle (n 9). Imaging studies included panoramic, standardized cephalometric tomograms, and lateral cephalometric radiographs preoperatively and postoperatively. The diagnosis for osteochondroma was confirmed in each patient by histopathologic analysis. All patients had 1) resection of the condylar head, 2) recontouring of the condylar neck to form a new condyle, 3) articular disc repositioning over the condylar stump, and 4) indicated orthognathic surgical procedures for repositioning of the condylar stump and disc into the fossa and correcting other associated dentofacial deformities. Postoperative follow-up averaged 36 months (6 to 108 months). Results: All but one patient required double jaw surgery to correct the associated jaw deformities. At longest follow-up, maximum incisal opening increased an average of 3.6 mm, whereas contralateral excursive movements decreased an average of 1.3 mm. Fourteen patients maintained a stable dentoskeletal relationship and a Class I dental occlusion postsurgically, and 1 patient experienced a 3 mm anterior open bite when seen at 5 years postsurgery secondary to orthodontic relapse, which was subsequently corrected orthodontically. No recurrence of the tumors occurred in any of the patients. The table lists the average values and ranges: