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Clinical Practice Guideline: Condylar Hyperplasia of the Mandible—Diagnosis and Treatment
Merle Riechmann1, Nils-Claudius Gellrich, Bodo Kress
1Department of Oral- and Craniomaxillofacial Plastic Surgery, University Hospital of Marburg; Department of Otolaryngology at University Hospital Münster; Department for Oral and Maxillofacial Surgery, Hanover Medical School; Central Institute for Radiology and Neuroradiology, Nordwest Hospital, Frankfurt am Main; Department of Oral- and Craniomaxillofacial Plastic Surgery, University Hospital of Marburg; Institute for Radiology and Nuclear Medicine, GPR Hospital, Rüsselsheim am Main; Pediatric Radiology at the Open MRI in Kiel; Department of Oral- and Craniomaxillofacial Plastic Surgery, University Hospital of Marburg.
Background:
Condylar hyperplasia of the mandible is characterized by abnormal size and configuration of the condylar process. In Germany, the administrative prevalence of diagnosed and/or treated condylar hyperplasia is 2.4-9.6 cases per 100 000 persons. Misdiagnosis is common and can lead to severe esthetic and functional complications, including facial deformity that can progress into the patient's twenties, as well as dysfunctional speech and mastication.
Methods:
We conducted a systematic review of the literature and a structured consensus-finding process with the Delphi method.
Results:
The experts recommend timely diagnosis of condylar hyperplasia so that its progression can be prevented by appropriate treatment. The basic diagnostic evaluation consists of history taking, physical examination, and imaging with orthopantomography. If condylar hyperplasia is confirmed, three-dimensional imaging is performed, usually with SPECT. The treatment is mainly surgical: partial condylectomy techniques and orthognathic surgery are the most common methods. If left untreated, the disorder causes severe dysfunction of mastication as well as disfigurement. Most studies of treatments for condylar hyperplasia have been based on low case numbers and have yielded only level 4 or level 5 evidence.
Conclusion:
Condylar hyperplasia is a common, but not widely known problem. Its early diagnosis and treatment can prevent severe jaw asymmetry and further complications such as craniomandibular dysfunction and arthrosis of the temporomandibular joints.
