Pushkar Mehra1, Varun Arya2, Charles Henry3. 1. Chairman, Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston; Chief, Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA. Electronic address: pushkar.mehra@bmc.org. 2. Resident, Department of Oral and Maxillofacial Surgery, Boston University Henry M. Goldman School of Dental Medicine, Boston; Boston Medical Center, Boston, MA. 3. Private Practice in Oral and Maxillofacial Surgery, Keene, NH; Attending Surgeon, Boston Medical Center, Boston, MA.
Abstract
PURPOSE: Recommended treatment for patients with osteochondromas of the mandibular condyle is to perform complete condylectomy with joint replacement. Low condylectomy with joint preservation has recently been proposed as a treatment option. This study compared the outcomes of these treatment options in patients with condylar osteochondromas. PATIENTS AND METHODS: Patients were divided into 2 groups: patients who underwent complete condylectomy and joint replacement (group A, n = 13) and patients who underwent low condylectomy and joint preservation (group B, n = 8). To optimize occlusion, function, and esthetics, maxillary and mandibular orthognathic procedures were performed as necessary to re-establish vertical ramus height. Outcomes were measured clinically and radiographically. RESULTS: The 2 groups showed significant clinical improvement (P < .05), with no tumor recurrence. Group A had increased operating room (OR) time and donor-site complications in those who received autogenous joint reconstruction compared with alloplastic joint replacement. Group B had a shorter OR duration with quicker postoperative recovery. Orthognathic procedures were stable in all cases. CONCLUSIONS: Complete and low condylectomies are viable options for the surgical management of osteochondromas of the mandibular condyle. If temporomandibular joint (TMJ) reconstruction is required, patient-fitted TMJ replacements provide similar clinical outcomes as autogenous reconstruction, but have the advantages of eliminating donor-site morbidity and decreasing operating time.
PURPOSE: Recommended treatment for patients with osteochondromas of the mandibular condyle is to perform complete condylectomy with joint replacement. Low condylectomy with joint preservation has recently been proposed as a treatment option. This study compared the outcomes of these treatment options in patients with condylar osteochondromas. PATIENTS AND METHODS: Patients were divided into 2 groups: patients who underwent complete condylectomy and joint replacement (group A, n = 13) and patients who underwent low condylectomy and joint preservation (group B, n = 8). To optimize occlusion, function, and esthetics, maxillary and mandibular orthognathic procedures were performed as necessary to re-establish vertical ramus height. Outcomes were measured clinically and radiographically. RESULTS: The 2 groups showed significant clinical improvement (P < .05), with no tumor recurrence. Group A had increased operating room (OR) time and donor-site complications in those who received autogenous joint reconstruction compared with alloplastic joint replacement. Group B had a shorter OR duration with quicker postoperative recovery. Orthognathic procedures were stable in all cases. CONCLUSIONS: Complete and low condylectomies are viable options for the surgical management of osteochondromas of the mandibular condyle. If temporomandibular joint (TMJ) reconstruction is required, patient-fitted TMJ replacements provide similar clinical outcomes as autogenous reconstruction, but have the advantages of eliminating donor-site morbidity and decreasing operating time.
Authors: Marco Antonio de Oliveira Filho; Luis Eduardo Almeida; Andrea Duarte Doetzer; Allan Fernando Giovanini; Osvaldo Malafaia Journal: Case Rep Surg Date: 2020-02-06